Thrombotic thrombocytopenic purpura developed during the conservative treatment of anti-phospholipase A2 receptor antibody-positive idiopathic membranous nephropathy: a case report

BMC Nephrology

Masanori Matsumoto¹  Kensuke Mitsumoto²  Yukimasa Iwata²  Tatsuya Shoji²  Hiroki Okushima²  Terumasa Hayashi²  Naomi Ota²  Kodo Tomida²  Karin Shimada²  Rei Iio²  Hiroaki Fushimi³  Shin’ichi Akiyama⁴ 

[1] Department of Blood Transfusion Medicine, Nara Medical University, 840 Shijyo-cho, 634-8522, Kashihara, Nara, Japan;Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan;Department of Pathology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan;Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan;

关键词: Anti-PLAR antibody;    Idiopathic membranous nephropathy;    ADAMTS13 inhibitor;    Acquired thrombotic thrombocytopenic purpura;   

DOI  :  10.1186/s12882-020-02086-z

来源: Springer

【 摘 要 】

BackgroundIdiopathic membranous nephropathy (MN) is one of the major glomerulonephritis that cause nephrotic syndrome. The phospholipase A2 receptor (PLA2R) has recently been identified as an endogenous antigen of idiopathic MN. Thrombotic thrombocytopenic purpura (TTP) is a disorder characterized by schistocytes, hemolytic anemia, thrombocytopenia, and organ dysfunction which occurs as a result of thrombi. Patients with acquired TTP have autoantibodies against a disintegrin and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13). These autoantibodies act as an inhibitor and cause ADAMTS13 deficiency. Idiopathic MN and acquired TTP are usually considered as independent autoimmune diseases. We experienced a patient who developed TTP during the conservative treatment of idiopathic MN, with the coexistence of ADAMTS13 inhibitor and anti-PLA2R antibody.Case presentationA 73-year-old man presented with thrombocytopenia, hemolytic anemia, disturbance of consciousness, and acute kidney injury after 4-year course of biopsy-proven idiopathic MN. ADAMTS13 activity was undetectable and the ADAMTS13 inhibitor was identified. Additionally, he was positive for anti-PLA2R antibody. The patient did not have any diseases that could cause secondary thrombotic microangiopathy, and he was diagnosed with acquired TTP. Steroid therapy and plasma exchange were initiated and the acquired TTP resolved. MN achieved remission 3 months after the anti-PLA2R antibody disappeared.ConclusionsThis is the first reported case of acquired TTP developed during conservative treatment of idiopathic MN, with both ADAMTS13 inhibitor and anti-PLA2R antibody positive at the onset of the TTP. The present case suggests that idiopathic MN might be associated with the development of some cases of acquired TTP.

【 授权许可】

CC BY