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. 2014 May;3(1):5-9.
doi: 10.1007/s13730-013-0074-1. Epub 2013 Mar 18.

Monitoring with serum SP-A, SP-D, and KL-6 in a patient with interstitial pneumonia complicated with ANCA-associated glomerulonephritis

Fumihiko Takahashi  1   2 , Eriko Miura  3 , Kiyoko Shibukawa  3 , Junko Chinda  3 , Naoyuki Miyokawa  4 , Chieko Imamoto  5 , Kenjiro Kikuchi  3 , Naoyuki Hasebe  3
Affiliations

Monitoring with serum SP-A, SP-D, and KL-6 in a patient with interstitial pneumonia complicated with ANCA-associated glomerulonephritis

Fumihiko Takahashi et al. CEN Case Rep. 2014 May.

Abstract

A 69-year-old woman was admitted to hospital, complaining of fatigue and dry cough. Her renal function deteriorated rapidly, and the laboratory findings showed elevated myeloperoxidase-specific anti-neutrophil cytoplasmic antibody (ANCA). Renal biopsy examination revealed crescentic glomerulonephritis (pauci-immune type), and linear opacities and a honeycomb appearance in both lower lobes was evident on the chest computed tomography scan. The patient was diagnosed as having ANCA-associated glomerulonephritis complicated with mild interstitial pneumonia (IP). Treatment with methylprednisolone pulse therapy improved both her renal function and IP, but her lung lesions worsened during the course of tapering the prednisolone doses. After careful observation, her IP improved gradually without specific treatment. Worsening or improvement of her lung lesions was accompanied by changes in the serological markers of IP, namely, surfactant protein-A, surfactant protein-D, and KL-6. We found that monitoring these markers was helpful in diagnosing and managing IP in our patient with ANCA-associated vasculitis.

Keywords: Anti-neutrophil cytoplasmic antibody; Interstitial pneumonia; KL-6; Surfactant protein-A; Surfactant protein-D.

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Figures

Fig. 1
Fig. 1
Chest computed tomography revealing linear opacities and honeycomb appearance in the both lower lobes
Fig. 2
Fig. 2
Light micrograph of a kidney biopsy specimen. Crescent formation and hyalinosis in the glomeruli are present (hematoxylin and eosin staining; ×200)
Fig. 3
Fig. 3
Clinical course of the patient. mPSL Methyl-prednisolone, PSL prednisolone, SP-A surfactant protein-A, SP-D surfactant protein-D, Cre serum creatinine concentration, MPO–ANCA myeloperoxidase-specific anti-neutrophil cytoplasmic antibody, CT computed tomography
Fig. 4
Fig. 4
a Chest CT scan revealing ground-glass opacities in the both lungs, suggesting the deterioration of interstitial pneumonia. b Chest CT scan showing improvement of her interstitial pneumonia
See this image and copyright information in PMC

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