Case Report

Pauci-Immune Crescentic Glomerulonephritis in Connective Tissue Disease

Table 1


Clinical features⁢Kidney biopsyAntibodies and C3, C4
HistologyIF and EM findings

Charney et al. # A [5]Raynaud’s phenomenon, pulmonary fibrosis, esophageal dysmotility, and TTPDPGN with thrombotic microangiopathyTrace IgG, IgM, and no C1q, C3, IgA, or fibrinogen.
No deposits on EM
Positive ANA with 1 : 640 titer and speckled pattern and lupus anticoagulant.
Negative anti-dsDNA and ANCA. Normal C3, C4

Charney et al. # B [5]NDDPGN with necrotizing lesions, crescents, and thrombotic microangiopathy2+ IgM and fibrinogen.
Few scattered subepithelial deposits on EM
Positive ANA with 1 : 640 and homogeneous pattern and positive anti-dsDNA. Negative ANCA. Low C3 and C4

Charney et al. # C [5]Arthritis, leukopenia, coombs-positive hemolytic anemia, and serositisDPGN with 40% sclerosis and 10% cellular and fibrous crescents IgM (2+), IgA (1+), C1q (1+), and fibrinogen (1+). Scattered mesangial deposits on EMPositive ANA with 1 : 640 titer and speckled pattern and anti-dsDNA, SS-A, and SS-B. Negative ANCA. Normal C3, C4

Charney et al. # D [5]Diagnosed with SLE, features are not describedDPGN and thrombotic microangiopathyMild staining for IgG, IgM, and C3Positive ANA with 1 : 140 titer, homogeneous pattern, and positive dsDNA. Negative ANCA and anticardiolipin. Low C3 and C4

Charney et al. # E [5]ArthritisDPGN and thrombotic microangiopathyMild IgG and C3.
Rare mesangial and intramembranous deposits on EM
Positive ANA with 1 : 320 titer, homogenous pattern, and anti-dsDNA, anticardiolipin IgG. Negative ANCA. Low C3 and normal C4

Hervier et al. # A [6]Arthritis, hemolytic anemia, thrombocytopenia, sinusitis, cerebral ischemia, and intra-alveolar hemorrhageDiffuse and global proliferative and crescentic GNEndomembranous and mesangial IgG, IgM, and C3 depositsPositive ANA with 1 : 5120 titers, homogenous pattern, anti-dsDNA, and MPO ANCA. Low C3

Hervier et al. # B [6]Discoid lupus, arthralgia, thrombocytopenia, and epistaxisProliferative crescentic GN, without mesangial proliferation or IgG depositsPositive ANA with 1 : 640 titer, speckled pattern, anti-dsDNA, and MPO ANCA

Hervier et al. # C [6]Arthritis, serositis, thrombocytopenia, anemia, rhinitis, excavated pulmonary nodules, and leukocytoclastic vasculitisProliferative and necrotic GNIgG and IgA depositsPositive ANA with 1 : 2560 titer, homogenous pattern, anti-dsDNA, MPO ANCA, lupus anticoagulant, and anticardiolipin. Low C3 and C4

Hervier et al. # D [6]Discoid lupus, arthritis, pericarditis, thrombocytopenia, and intra-alveolar hemorrhageNDNDPositive ANA with 1 : 160 titer and MPO ANCA. Negative dsDNA. Low C3

Li et al. # A [4]Rash, hemolytic anemiaDPGN with fibrocellular crescentsNo immunofluorescence deposits. Scanty subepithelial electron dense deposits on EMPositive ANA, 1 : 320 titer, and homogenous pattern. Negative anti-dsDNA, anti-PR-3, and anti-MPO antibody. Low C3 and C4

Akhtar et al. # A [3]Arthritis, alopecia, and AIHADiffuse mesangial cellularity, segmental cellular proliferation with necrosis. No crescents1+ focal staining for IgG and C3Positive ANA with 1 : 2560 titer, peripheral pattern, and IgM, IgG anticardiolipin. Negative anti-dsDNA, RF, and ANCA. Low C3 and C4

Akhtar et al. # B [3]Arthritis, Raynaud’s phenomenon, serositis, rash, and oral ulcersCellular proliferation of glomeruli with areas of necrosis. No crescents1+ focal staining in some mesangial areas.
Small mesangial deposits
Positive ANA with 1 : 2560 titer, homogenous pattern, anti-dsDNA, and SS-A/SS-B. Negative RF, ANCA. Low C4

Marshall et al. # A [7]PancytopeniaSegmental necrotizing GN with cellular crescents2+ IgG and C3, negative IgM, IgA, and C1.
No subendothelial electron dense deposits
Positive ANA, 1 : 160, speckled pattern, anti-dsDNA, anti-histone antibody, and P-ANCA. Negative C-ANCA. Low C3 and normal C4

Marshall et al. # B [7]Serositis, sinusitis, and pulmonary infiltratesDiffuse thickening of glomerular basement membranes, segmental necrotizing GN with cellular crescents3+ IgG, 2+ C3, and trace IgM. No subendothelial electron dense depositsPositive ANA with 1 : 80 titer, P-ANCA, and MPO antibody. Negative C-ANCA, anti-dsDNA. Normal C3 and C4

Fayaz et al. # A [2]Arthritis, rash, photosensitivity, and leukopeniaSegmental and focal proliferative fibrinoid necrosisNo IF deposits.
No electron dense deposits
Positive ANA with 1 : 640 titer, homogeneous pattern, and anti-dsDNA. Negative ANCA, anti-MPO, and PR-3 antibodies. Low C3, normal C4

TTP: thrombotic thrombocytopenic purpura, IF: immunofluorescence, EM: electron microscopy, AIHA: autoimmune hemolytic anemia, MPO: myeloperoxidase, PR-3: proteinase 3, ND: not described, GN: glomerulonephritis, and DPGN: diffuse proliferative GN.