J Korean Rheum Assoc.  2010 Sep;17(3):311-315.

Two Cases of ANCA-associated Pauci-immune Glomerulonephritis with Rheumatoid Arthritis

• Koo BS
• Kim YG
• Choi JG
• Ahn YC
• Lee SG
• Lee CK
• Yoo B

Abstract

Renal involvement is one of the extra-articular manifestations found in patients with rheumatoid arthritis (RA). Membranous glomerulonephopathy, membranoproliferative glomeruonophritis, secondary amyloidosis, and focal segmental glomerulosclerosis are reported as pathologic diagnoses of renal involvement. However, reports of renal involvement in patients with RA and antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune glomerulonephritis are rare. Recently, we experienced two patients with RA who developed azotemia and were finally diagnosed with ANCA-associated pauci-immune glomerulonephritis. Because of the rarity of these cases, we report two cases in patients with RA with a literature review.

Keyword

Rheumatoid arthritis; Antineutrophilic cytoplasmic antibody; Glomerulonephritis

MeSH Terms

Amyloidosis
Arthritis, Rheumatoid
Azotemia
Cytoplasm
Glomerulonephritis
Glomerulosclerosis, Focal Segmental
Humans
Glomerulosclerosis, Focal Segmental

Figure

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  Fig. 1. The glomerulus reveals a crescent formation (white arrow). The mesangium is expanded due to an increase of matrix with segmental hypercellularity and focal neutrophilic infiltration. (silver stain, ×400).

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  Fig. 2. The glomerulus is globally sclerotic (white arrow). Diffuse interstitial inflammatory cell infiltration (mostly lymphoplasma cells and occasional neutrophils) is seen, with severe interstitial fibrosis and tubular atrophy (black arrow) (silver stain, ×400).

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