A Case of Bad Prognosis for Membranous Nephropathy in a Patient with Mixed Connective Tissue Disease

Mi Young Kim; Ho Seok Koo; Young Ki Seo; Jung Hwa Min; Kyung Jin Lee; Soo Yeon Jo; Haeng Il Koh

doi:10.4078/jrd.2015.22.4.260

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Kim, Koo, Seo, Min, Lee, Jo, and Koh: A Case of Bad Prognosis for Membranous Nephropathy in a Patient with Mixed Connective Tissue Disease

Case Report

J Rheum Dis 2015;22(4):260-262.

Published online: 31 October 2015

DOI: https://doi.org/10.4078/jrd.2015.22.4.260

A Case of Bad Prognosis for Membranous Nephropathy in a Patient with Mixed Connective Tissue Disease

Mi Young Kim², Ho Seok Koo¹, Young Ki Seo², Jung Hwa Min², Kyung Jin Lee², Soo Yeon Jo², Haeng Il Koh¹

¹Division of Nephrology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

²Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

Corresponding to: Ho Seok Koo, Division of Nephrology, Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea. E-mail: hoseok.koo@gmail.com

Received 9 June 2014 Revised 22 September 2014 Accepted 22 September 2014

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Incidence of renal involvement in mixed connective tissue disease (MCTD) is low. In the presence of glomerulonephritis, membranous nephropathy (MN) in MCTD is common. A 47-year-old woman presented with hypothyroidism. She developed Raynaud's phenomenon, arthralgia, and incomplete lupus erythematosus, diagnosed with MCTD. One year after then, the patient developed persistent proteinuria (1+) without hematuria. Following diagnosis with MCTD, her renal function began to deteriorate. The renal biopsy showed late stage MN. For the treatment of MN with mild proteinuria and MCTD, we prescribed an angiotensin II receptor blocker and 7.5 mg of methotrexate per week and 300 mg of hydroxychloroquine daily. The patient had a reduced estimated glomerular filtration rate of 55% for the subsequent eight years. The MN in MCTD is known to show good renal prognosis. Here, we report on a rare case of MN in MCTD in Korea with a bad prognosis.

Keywords: Mixed connective tissue disease, Glomerulonephritis, Membranous glomerulonephritis

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Figure 1.

(A) Glomeruli sclerosis of 23.1% involves mesangial cells and endothelial cells (H&E, ×400). (B) Immunoglobulin G was slightly stained in the periphery (IF, ×400). (C) Electron-dense deposits were in some subepithelial and intramembranous deposits. The diffuse effacement of podocyte foot process and a dome and spike formation were evident (EM, ×10,000).

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