2008 Volume 21 Issue 2 Pages 176-181
Asymptomatic microhematuria and proteinuria were detected by school urinalysis screening in a 12-year-old Japanese female patient, whose case we followed for the subsequent two years, and diagnosed as antineutrophil cytoplasmic antibodies (ANCA) associated glomerulonephritis.
She developed rapid progressive renal dysfunction and positive results for myeloperoxidase (MPO)-ANCA. As the initial treatment, we employed methylprednisolone pulse (MP) therapy, and her renal function improved significantly. Two months later, she experienced an exacerbation concomitant with infectious enterocolitis. She again received MP, and second percutaneous renal biopsy. The light microscope findings of renal biopsy specimen demonstrated progressive screlotic change, and global sclerosis, accordingly we discontinued MP, and started oral prednisolone (PSL), mizoribine (MZB), and other drugs. Although she retained renal function, clinical manifestations-microscopic hematuria and proteinuria-have persisted. MPO-ANCA titers were within normal ranges for about six months after the exacerbation, however then rose gradually. The patient received intravenous pulse cyclophosphamide (IVCY) for four months to decrease MPO-ANCA titers, but the response was not satisfactory. With persistent microscopichematuria and proteinuria, careful follow-up is required.
