The clinical and immunological features of the post-extracorporeal shock wave lithotripsy anti-glomerular basement membrane disease

Figures & data

Table 1. Clinical, pathological, and immunological features of patients with post-ESWL anti-GBM disease in our hospital.

	Patient 1	Patient 2	Patient 3
Sex/age, y	M/36	M/50	F/74
Hydrocarbon exposure (Y/N)	Y	N	N
Smoking (Y/N)	Y	Y	N
Prodromal infection (Y/N)	Y	N	Y
Fever (Y/N)	Y	Y	Y
Pulmonary hemorrhage (Y/N)	Y	N	N
Gross hematuria (Y/N)	Y	Y	Y
Oliguria/Anuria (Y/N)	Y	N	Y
Hemoglobin on diagnosis, g/L	49.0	102.0	63.0
Serum albumin, g/L	30.0	27.1	29.0
Urinary protein, g/24h	2.0	1.6	0.6
Nephrotic syndrome (Y/N)	N	N	N
Serum creatinine on diagnosis, μmol/L	1279	364	1066
eGFR on diagnosis, mL/min/1.73m^2	4.0	15.0	3.0
Anti-GBM antibodies on diagnosis, RU/mL	>200	183	196
Positive ANCA (Y/N)	N	N	N
Treatment	PE/MP/Pred/CTX	PE/MP/Pred	MP/Pred/CTX
Anti-GBM antibody on discharge, RU/mL	33	51	102
Serum creatinine on discharge, μmol/L	425	353	618
eGFR on discharge, mL/min/1.73 m^2	14.0	16.3	5.3
Dialysis-dependent on discharge (Y/N)	N	Y	Y
Duration of follow-up, m	3	60	48
Dialysis-dependent at last follow-up (Y/N)	N	Y (PD)	Y (HD)
Death at last follow-up (Y/N) (cause of death)	N	N	Y (Esophagus cancer)
Stone location	kidney	ureter	kidney
Total ESWL number	1	1	1
ESWL-to-onset interval, m	24	22	10
Anti-α1(IV)NC1 antibody (ref range, <0.04)	0.06	0.89	0.33
Anti-α2(IV)NC1 antibody (ref range, <0.05)	0.01	0.83	0.12
Anti-α3(IV)NC1 antibody (ref range, <0.06)	2.11	2.08	2.15
Anti-α4(IV)NC1 antibody (ref range, <0.58)	0.27	1.43	0.70
Anti-α5(IV)NC1 antibody (ref range, <0.02)	0.00	0.48	0.10
Anti-α3EA antibody (ref range, <0.07)	1.39	1.67	1.61
Anti-α3EB antibody (ref range, <0.15)	0.59	1.54	1.35
Anti-α3(IV)NC1 IgG1 (ref range, <0.02)	0.68	0.57	0.73
Anti-α3(IV)NC1 IgG2 (ref range, <0.07)	1.51	1.32	1.25
Anti-α3(IV)NC1 IgG3 (ref range, <0.01)	0.53	0.49	0.63
Anti-α3(IV)NC1 IgG4 (ref range, <0.01)	2.34	0.56	0.43

M: male; F: female; eGFR: estimated glomerular filtration rate; GBM: glomerular basement membrane; ANCA: anti-neutrophil cytoplasmic antibody; PE: plasma exchange; MP: methylprednisolone pulse; Pred: prednisone; CTX: cyclophosphamide; PD: peritoneal dialysis; HD: hemodialysis; ESWL: extracorporeal shock wave lithotripsy; IgG: immunoglobulin G; ref: reference; Y: yes; N: no.

Figure 1. Renal pathology of patient 3 with post-extracorporeal shock wave lithotripsy (ESWL) anti-GBM disease showed cellular crescent formation in a glomerulus by periodic acid-silver methenamine and Masson trichrome stain on light microscopy (400×).

Table 2. Clinical and pathological data of previously reported post-ESWL anti-GBM disease cases.

	1	2	3	4	5
Authors	Cranfield et al.	Sellin et al.	Xenocostas et al.	Iwamoto et al.	Guerin et al.
Publication year	2015	2005	1999	1998	1990
Sex/age, y	F/67	M/32	M/72	F/37	M/67
Hydrocarbon exposure (Y/N)	NA	NA	NA	NA	NA
Smoking (Y/N)	NA	NA	NA	NA	Y
Prodromal infection (Y/N)	N	N	Y	N	N
Fever (Y/N)	Y	Y	Y	Y	Y
Pulmonary hemorrhage(Y/N)	Y	N	N	N	N
Gross hematuria (Y/N)	NA	Y	N	Y	NA
Serum creatinine on diagnosis, μmol/L	1179	919	NA	1114	1074
Positive anti-GBM antibody(Y/N)	Y	Y	Y	Y	Y
Positive ANCA (Y/N)	N	NA	N	N	N
HLA phenotype	DR4, DQ6	DRB1*11 & 13	DR15	DR2	DR2
Treatment	PE/MP/Pred/CTX	Pred/CTX	NA	PE/MP/Pred/CTX	NA
Dialysis-dependent (Y/N)	Y	Y	Y	Y	Y
Renal biopsy (Y/N)	NA	Y	Y	Y	Y
Immunofluorescence	NA	Linear IgG deposits along GBM	Linear IgG deposits along GBM	Linear IgG and C3 deposits along GBM	Linear IgG and C3 deposits along GBM
Light microscopy	NA	Crescent formation in 23/25 glomeruli	Crescent formation in nearly all glomeruli	Cellular crescents in all glomeruli	Cellular crescents in all glomeruli
Electron-dense deposits on electron microscopy	NA	NA	N	N	NA
Stone location	NA	Infundibulum	Left renal pelvis	Right kidney	Left kidney
Stone component	NA	Calcium oxalate	NA	NA	NA
Total ESWL number	2 within 4 weeks	3 within 4 months	1	NA	2 within 10 days
ESWL-to-onset interval	1 week	5 months	3 months	3 months	7 months
Shock number	3200	NA	4000	1000	NA
Energy data	75 kPa	NA	NA	17 kV	NA
Renal function at last ESWL	NA	NA	Normal	Normal	Normal
Anti-GBM antibody before ESWL	NA	NA	NA	Negative	Negative

F: female; M: male; GBM: glomerular basement membrane; ANCA: anti-neutrophil cytoplasmic antibody; HLA: human leukocyte antigen; PE: plasma exchange; MP: methylprednisolone pulse; Pred: prednisone; CTX: cyclophosphamide; IgG: immunoglobulin G; C3: complement 3; ESWL: extracorporeal shock wave lithotripsy; ref: reference; Y: yes; N: no; NA: not available.