Wang B. et al., 2021: The clinical and immunological features of the post-extracorporeal shock wave lithotripsy anti-glomerular basement membrane disease
Wang B, Xiaoyu J, Yu X, Cui Z, Zhao M.
Renal Division, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.
Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Peking-Tsinghua Center for Life Sciences, Beijing, China.
Abstract
Introduction: Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive modality to treat urolithiasis, with complications including tissue damage and hematoma of kidney parenchyma. Anti-glomerular basement membrane (GBM) disease is suggested to be a rare complication of ESWL since it was reported in several cases to occur after ESWL. However, the clinical and immunological features of the ESWL-associated anti-GBM disease have not been fully investigated so far.
Case presentation: Here, we present the clinical, pathological, and immunological characteristics of three patients with the post-ESWL anti-GBM disease in our hospital. Anti-GBM disease occurred within a median of 22 months after ESWL treatment. It presented with similar clinical features to the classic anti-GBM disease, including fever, gross hematuria, and rapidly progressive glomerulonephritis (RPGN) with poor renal prognosis. Sera from all patients recognized the α3(IV)NC1 in GBM, but with IgG2 and IgG4 as the dominant IgG subclasses.
Conclusion: Although further exploration is required to prove the causal relationship in this rare condition, our study reminds physicians that patients developing acute renal insufficiency after ESWL should lead to the suspicion of anti-GBM disease and in-time diagnosis and treatment.
Ren Fail. 2021 Dec;43(1):149-155. doi: 10.1080/0886022X.2020.1869042. PMID: 33435789. FREE ARTICLE
Comments 1
These three cases of a rare renal autoimmune disease are 1.81% of all 166 anti-GBM patients seen in that hospital in 10 years. They developed 10, 22, and 24 months after ESWL resp. A literature review of the authors revealed five previous cases of a post-ESWL anti-GBM disease. The authors see a limitation of their study: “The number of cases is too small to draw the causal relationship between ESWL and anti-GBM disease.”
I missed a reference (1) which did not find any changes of the relevant antibodies in a prospective study of patients before and 3 years after ESWL.
1 Westman KW, et l . Prevalence of autoantibodies associated with glomerulonephritis, unaffected after extracorporeal shock wave lithotripsy for renal calculi, in a three-year follow-up. Scand J Urol Nephrol. 1997 Oct;31(5):463-7. doi: 10.3109/00365599709030644
Peter Alken