Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 54, Issue 3, Pages 542-545Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2009.02.016
Keywords
Vasculitis; microscopic polyangiitis (MPA); antineutrophil cytoplasmic antibodies (ANCAs); myeloperoxidase (MPO)
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Funding
- NATIONAL CENTER FOR RESEARCH RESOURCES [U54RR019497] Funding Source: NIH RePORTER
- NCRR NIH HHS [U54-RR-019497] Funding Source: Medline
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Myeloperoxidase (MPO)-specific antineutrophil cytoplasmic antibodies have been proposed as pathogenic for microscopic polyangiitis. Supporting this hypothesis, a case report of transplacental anti-MPO antibody transfer presumably causing a vasculitis-like syndrome in the newborn is cited frequently. Here, we report a case of transplacental transfer of high levels of anti-MPO antibodies not resulting in clinical compromise in the newborn. The mother developed microscopic polyangiitis 5 years before the pregnancy. After induction therapy, remission was maintained with low-dose prednisone and azathioprine for 4.5 years despite high levels of anti-MPO antibodies (> 100 U/mL). The patient elected to become pregnant, immunosuppression was maintained during pregnancy, and a normal-term neonate was delivered. The newborn's venous blood anti-MPO antibody levels decreased gradually from greater than 100 U/mL at birth to undetectable by day 120. No clinical manifestation of vasculitis developed in the newborn. This case supports that anti-MPO antibodies alone are not pathogenic without additional cofactors. Am J Kidney Dis 54:542-545. (C) 2009 by the National Kidney Foundation, Inc.
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