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Case report
Case of immunotactoid glomerulopathy showing high responsiveness to steroids therapy despite severe pathological features
  1. Atsuki Ohashi1,
  2. Jiro Kumagai2,
  3. Kiyotaka Nagahama3 and
  4. Hajime Fujisawa1
  1. 1 Nephrology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
  2. 2 Pathology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
  3. 3 Pathology, Kyorin University, Tokyo, Japan
  1. Correspondence to Dr Atsuki Ohashi, atsuki_med1028{at}yahoo.co.jp

Abstract

A 72-year-old woman presented with nephrotic proteinuria and moderate haematuria. Renal pathology was compatible with immunotactoid glomerulopathy (ITG), for which there is no consensus for appropriate therapy. We, therefore, postponed immunosuppressive therapy. After 4 years, the patient’s renal function started to decline and renal pathology was re-evaluated, revealing a pathological change from mesangial proliferative glomerulonephritis to endocapillary proliferative glomerulonephritis. Treatment with oral prednisolone (30 mg/day) was initiated. Within 5 weeks, complete remission of proteinuria was obtained (proteinuria 6.02 g/gCr to 0.12 g/gCr), and the patient’s renal function stabilised. Generally, responsiveness to immunosuppressive therapy is poor in patients with ITG, and the present case represented a very rare clinical course. Some previous cases have indicated susceptibility to the therapy, regardless of the severity of renal damage. As a possible distinct entity that determines susceptibility to immunosuppressive therapy, we suggest the presence of a latent lymphoproliferative disease with no significant haematological symptoms.

  • nephrotic syndrome
  • proteinurea
  • pathology

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Footnotes

  • Contributors AO wrote the manuscript with support from HF. JK and KN gave advice about pathological interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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