Non-diabetic nodular glomerulosclerosis associated with p-ANCA seropositivity: a case report and review of the literature

Abstract

A 73-year-old white man with slowly progressive chronic renal failure and nephrotic-range proteinuria was found to have antineutrophil cytoplasmic antibody in a perinuclear pattern (p-ANCA) at a titer of 1:800. Renal histologic findings revealed an advanced scarring glomerulopathy with diffuse and nodular mesangial sclerosis. Light, electron, and immunofluorescence microscopic findings were highly suggestive of diabetic glomerulosclerosis. Interestingly, this patient had no history of diabetes mellitus or diabetic retinopathy. The presence of p-ANCA positivity can be found in patients with a broad range of renal histologic findings, and does not necessarily imply the existence of pauci-immune necrotizing crescentic glomerulonephritis. For this reason, we urge caution in the empiric cytotoxic treatment of p-ANCA-associated renal disease in stable patients. When possible, a tissue diagnosis should be made.