A case of membranous nephropathy and myeloperoxidase anti-neutrophil cytoplasmic antibody-associated glomerulonephritis

Membranous nephropathy (MN) may be a primary disease or secondary to autoimmune conditions such as systemic lupus erythematosus, infection (for example, with hepatitis B or C virus), cancer or drugs. In primary MN, crescents are rarely observed. Therefore, the presence of crescents suggests another underlying disease, for example lupus nephritis, anti-glomerular basement membrane disease or anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN). The coexistence of primary MN and ANCA-GN is rare. In the present case, a 51-year-old female with mild edema in the lower extremities for 1 year was admitted to hospital for renal biopsy. The serum test for myeloperoxidase (MPO)-ANCA was positive. The patient was diagnosed with stage 2 MN with crescentic glomerulonephritis type 3; however, no causal association was found between these two diseases in this case. Treatment was initiated with 500 mg methyl prednisolone for 3 days followed by 40 mg of oral methylprednisolone together with 50 mg cyclophosphamide twice per day. One month following treatment, the biochemical data results of the patient had improved.