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Production of anti-glomerular basement membrane antibody after extracorporeal shock wave lithotripsy
T Umekawa1, K Kohri, K Yoshioka
1Department of Urology, Kinki University School of Medicine, Osaka, Japan.
We report a case of acute renal failure occurring about 90 days after extracorporeal shock wave lithotripsy (ESWL) for a right renal stone. On left renal needle biopsy, immunofluorescence demonstrated linear fixation of IgG and C3 along the glomerular basement membrane (GBM). Serum circulating antitype IV collagen NC1 domain antibody was detected after ESWL, while it was not detected in the serum taken before ESWL. Based on these findings, the diagnose of anti-GBM antibody-mediated glomerulonephritis was made. Circulating antibodies against several GBM components (type IV collagen NC1 domain, laminin, fibronectin and heparan sulfate proteoglycan) was consistently negative in 9 randomly selected patients who underwent ESWL for renal stones. These findings suggest that the production of these autoantibodies associated with irradiation of shock waves to the kidney was not frequent, but, after ESWL, patients deserve close follow-up.
We report a case of acute renal failure occurring about 90 days after extracorporeal shock wave lithotripsy (ESWL) for a right renal stone. On left renal needle biopsy, immunofluorescence demonstrated linear fixation of IgG and C3 along the glomerular basement membrane (GBM). Serum circulating antitype IV collagen NC1 domain antibody was detected after ESWL, while it was not detected in the serum taken before ESWL. Based on these findings, the diagnose of anti-GBM antibody-mediated glomerulonephritis was made. Circulating antibodies against several GBM components (type IV collagen NC1 domain, laminin, fibronectin and heparan sulfate proteoglycan) was consistently negative in 9 randomly selected patients who underwent ESWL for renal stones. These findings suggest that the production of these autoantibodies associated with irradiation of shock waves to the kidney was not frequent, but, after ESWL, patients deserve close follow-up.