急速進行性糸球体腎炎に移行した膜性増殖性糸球体腎炎の1例

Abstract

A 60-year-old female with progression from membranoproliferative glomerulonephritis (MPGN) to rapidly progressive glomerulonephritis (RPGN) is report- ed. She was admitted to a certain hospital for investigation of proteinuria, where a renal biopsy specimen revealed MPGN (type Ⅰ). She was transferred to our hospital for treatment. A 24-hour urine sample contained 1.7 g protein. Renal function was normal : serum creatinine was 0.9 mg/dl (normal range : 0.3-0.9 mg/dl), and creatinine clearance 97 ml/min. An immunoserologic survey including antinuclear antibody, ds-DNA antibody, cryoglobulins, HBs antigen and HCV antibody was negative. Serum levels of C3 and C4 were normal. She was treated with prednisolone (40 mg/day) and warfarin. However, her proteinuria gradually increased to 17 g/day and serum creatinine increased to 1.3 mg/dl. A second biopsy performed 5 months after the first revealed PRGN with 64% of glomeruli with crescent formation. These findings indicate that MPGN (type Ⅰ) can progress to RPGN despite the use of corticosterioid and anti-coagulant therapy.