Table 1.
Clinical details of patients with membranous nephropathy and concomitant vasculitic glomerulonephritis.
| Title/authors | Patient (age/sex) | PLA2R | ANCA by IF | ANCA specificity by ELISA | Treatment | Prognosis |
|---|---|---|---|---|---|---|
| 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/F | PR3 | Oral prednisolone and IV rituximab | Renal 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 years | Renal function improved in 3 patients; 2 patients required RRT; 3 patients died: one of systemic vasculitis and 2 of sepsis | ||||
| 30/M | C-ANCA | Oral prednisolone and cyclophosphamide | Stable renal function. Complication: squamous lung CA 10 years after presentation | |||
| 39/M | Negative | Oral prednisolone and cyclophosphamide | Recovery. Complication: steroid-induced DM. Duration of follow-up: 7 months | |||
| 41/M | Negative | Oral prednisolone and cyclophosphamide | Stable renal function, duration of follow-up: 3 years | |||
| 58/F | Negative | Oral prednisolone and cyclophosphamide | Dialysis, duration of follow-up: 7 years | |||
| 63/M | NA | Oral prednisolone and azathioprine for 3 years, followed by prednisolone and cyclophosphamide | Death, duration of follow-up: 6 years | |||
| 64/M | P-ANCA | Oral prednisolone and azathioprine | Dialysis, duration of follow-up: 2 years | |||
| 65/M | P-ANCA | Oral prednisolone and cyclophosphamide | Recovery, duration of follow-up: 5 years | |||
| 65/M | Negative | Oral prednisolone and cyclophosphamide | Death (after 4 months) | |||
| 68/M | Negative | Oral prednisolone and cyclophosphamide | Death (after 2 months) | |||
| 70/M | C-ANCA | Oral prednisolone, cyclophosphamide, and plasma exchange | Recovery (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/M | C-ANCA | NA | Prednisone and cyclophosphamide | Resolution of pulmonary lesions, normalization of Cr, diminution of proteinuria | |
| 68/F | NA | MPO | Prednisone | Normalization of Cr | ||
| 47/F | P-ANCA | MPO | Methylprednisolone and then prednisone and cyclophosphamide | Diminution of proteinuria and disappearance of crescents (on repeat bx) | ||
| 67/M | P-ANCA | MPO | Prednisone and azathioprine | Dialysis | ||
| 69/M | P-ANCA | MPO | Prednisone and cyclophosphamide | Normalization of Cr | ||
| 68/F | N/A | MPO | Prednisone and cyclophosphamide | Partial 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 positive | ANCA positive | PR3 | Prednisone and cyclophosphamide | Recovery |
| 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/F | P-ANCA | MPO | Rituximab | Recovery | |
| 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/M | PLA2R positive | Negative ANCA | Negative | Prednisone and cyclophosphamide and then azathioprine for maintenance | Dialysis 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/M | PLA2R positive | Not reported | MPO | Not reported | Not reported |
| 63/F | PLA2R positive | Not reported | MPO | Not reported | Not 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/M | p-ANCA | Prednisolone, cyclophosphamide, and plasmapheresis | Recovery, 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 biopsy | 17 M and 10 F, with an age of 52.4 ± 17.7 years | 25 p-ANCA positive; 2 c-ANCA positive | 25 MPO positive and 2 PR3 positive | Prednisone and cyclophosphamide | 11 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 years | ANCA-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 MN | 38% PLA2R positive | All negative | All negative | ||
| No patient had positive anti-dsDNA, hep B and C, or HIV | ||||||
| 22/M | Negative | Negative | Prednisone and cyclophosphamide and then cyclosporine | Recovery, duration of follow-up: 138 months | ||
| 76/F | Negative | Negative | Prednisone and cyclophosphamide | Partial recovery, duration of follow-up: 26 months | ||
| 80/F | Negative | Negative | Mycophenolate mofetil and prednisone | Recovery, duration of follow-up:6 months | ||
| 69/F | Negative | Negative | Prednisone | ESRD, duration of follow-up: 1.5 months | ||
| 57/M | Negative | Negative | Prednisone and cyclophosphamide orally with remission; then azathioprine; then prednisone and cyclophosphamide | Duration of follow-up: 56 months | ||
| 41/M | Negative | Negative | Prednisone and cyclophosphamide | Worsening renal function, duration of follow-up:5 months | ||
| 20/F | Negative | Negative | None | ESRD, duration of follow-up: 35 months | ||
| 17/F | Negative | Negative | Enalapril | Recovery, duration of follow-up: 3 months | ||
| 50/M | Negative | Negative | Prednisone, cyclophosphamide, and mycophenolate | Partial recovery, duration of follow-up: 16 months | ||
| 5/F | Negative | Negative | Prednisone and mycophenolate (no response at 6 m); then, prednisone and cyclosporine; then, prednisone and tacrolimus | Recovery, duration of follow-up: 32 months | ||
| 86/M | Negative | Negative | Prednisone | Partial recovery, duration of follow-up: 11 months | ||
| 64/M | Negative | Negative | Prednisone and cyclosporine | Worsening renal function, duration of follow-up: 2 months | ||
| 72/F | Negative | Negative | Prednisone and cyclophosphamide | Partial recovery, duration of follow-up: 27 months | ||
| 62/M | Negative | Negative | Unknown | Partial recovery, duration of follow-up: 19 months | ||
| 64/M | Negative | Negative | Prednisone 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/M | Negative | Negative | Losartan | Partial recovery, duration of follow-up: 9 months | ||
| 58/M | Negative | Negative | Prednisone and cyclophosphamide orally for 2 m; then azathioprine for 1 y | Partial recovery, duration of follow-up: 11 months | ||
| 70/F | Negative | Negative | Unknown | Dialysis within 1 month | ||
| 56/M | Negative | Negative | Prednisone and cyclophosphamide | Partial 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/M | Not reported | p-ANCA | MPO | Methylprednisolone and cyclophosphamide | ESRD |
| Membranous glomerulonephritis with superimposed ANCA-associated vasculitis: Another case report; Antonio Granata, Fulvio Floccari [15] | 67/M | Not reported | p-ANCA | Not reported | Methylprednisolone and cyclophosphamide | Partial recovery |