Journal
INTERNAL MEDICINE
Volume 62, Issue 21, Pages 3175-3181Publisher
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.1023-22
Keywords
Helicobacter pylori; IgG4 kidney disease; membranous nephropathy; tubulointerstitial nephritis; multitarget therapy
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This article reports a case of IgG4-related membranous nephropathy treated with multitarget therapy and achieved remission.
IgG4-related membranous nephropathy (MN) is often refractory to glucocorticoid (GC) therapy, and treatment remains unclear. We herein report a 67-year-old Japanese man with IgG4-related MN and tubulointerstitial nephritis. A post-gastroscopy antibody test revealed Helicobacter pylori infection. After eradication, his proteinuria decreased indefinitely. We started prednisolone (30 mg/day), long-term GCs, and immunosuppressant therapy. However, remission proved challenging to achieve, with persistent proteinuria present at 1.0-2.0 g/gCr. We performed multitarget therapy for refractory IgG4-related MN, achieving proteinuria remission (<0.3 g/gCr). Multitarget therapy with low-dose GCs can resolve refractory IgG4-related MN through remission induction of proteinuria and minimize the risks associated with GC therapy.
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