Myeloperoxidase-Specific Anti-Neutrophic Cytoplasmic Autoantibodies - Related Scleroderma Renal Crisis Treated with Double-Filtration Plasmapheresis

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A 46-year-old female patient who was diagnosed with systemic sclerosis (SSc) developed rapidly progressive renal failure without elevation of blood pressure or plasma renin concentration. Renal biopsy revealed necrotizing crescentic glomerulonephritis (pauci-immune type) and the myeloperoxidase-speciflc anti-neutrophil cytoplasmic autoantibodies (MPO-ANCA) liter was found to be elevated to 669 EU/ml. Methylprednisolone (MP) pulse therapy followed by prednisolone (PSL) and mizoribine (MZR) did not suppress the progression of renal failure. Therefore, we started double-filtration plasmapheresis (DFPP) which effectively removed MPO-ANCA and prevented renal failure despite the relatively low dose of immunosuppressive agents.(Internal Medicine 36: 508-513, 1997)
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