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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">We were very interested by the comment submitted by Dr&#46; Gioacchino Li Cavoli and his collaborators&#44; regarding their similar experience of a membranous glomerulonephritis with crescentic overlap&#46; First of all&#44; we would like to thank them for their input&#46;</p><p class="elsevierStylePara">They reported a case of membranous glomerulonephritis &#40;MGN&#41; with crescentic transformation in a ANCA-negative vasculitis which revealed no evidence of systemic lupus erythematosus &#40;SLE&#41;&#44; anti-glomerular basement membrane &#40;GBM&#41; glomerulonephritis&#44; infection&#44; malignancy and showed no improvement after immunosuppressive treatments&#46; The case they presented was similar to the patient that Kwan JT et al&#46; described previously&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">1</span></span>&#160;Although several authors have demonstrated the concomitance of MGN and ANCA-associated glomerulonephritis&#44;<span class="elsevierStyleSup"><span class="elsevierStyleSup">2-6</span></span>&#160;MGN accompanied by ANCA-negative crescentic glomerulonephritis has been rarely encountered&#46;</p><p class="elsevierStylePara">The light microscopic visualization of renal tissue in their case showed the formation of 11 crescents &#40;3 cellular crescents&#44; 1 fibrocellular crescent and 7 fibrotic crescents&#41; and 11 out of 17 glomeruli were globally sclerotic&#46; These histopathological changes indicate the patient has reached to an advanced stage of crescentic glomerulonephritis and the renal disease has progressed to the sclerotic phase at the time of renal biopsy&#46; Nasr SH et al&#46; reported that the percentage of globally sclerotic glomeruli correlated with nonresponse to immunosuppressive agents&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">5</span></span>&#160;This is why the patient showed no improvement after treated with steroid plus cyclophosphamide and started chronic haemodialysis treatment eventually&#46; By contrast&#44; our case showed 2 sclerosed glomeruli out of 19 glomeruli&#44; the formation of 9 crescents including 4 cellular crescents and 5 fibrocellular crescents&#44; as well as the fibrinoid necrosis lesions upon light microscopy&#46; This indicates our patient might be at the relatively early stage of crescentic glomerulonephritis and the renal biopsy findings may interpret the better response to immunosuppressive treatments in our case&#46;</p><p class="elsevierStylePara">Concerning the prognosis of this group of patients&#44; Nasr SH et al&#46; reported that 50&#37; of patients had reached endpoints of end-stage renal stage &#40;ESRD&#41; or death whether or not treated with immunosuppressive agents and the only independent predictor of progression to ESRD was serum creatinine at biopsy&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">5</span></span>&#160;However&#44; the different outcomes of the two cases we and Dr&#46; Gioacchino Li Cavoli exhibited reveal that the histological finding is more reliable to predict the prognosis&#46; As Dr&#46; Gioacchino Li Cavoli mentioned in the comment&#44; the importance of recognizing the patients with membranous nephropathy and crescentic glomerulonephritis at early stage of the disease is that early immunosuppressive treatment may ameliorate the progression of renal damage and may contribute to the useful recovery of renal function&#46;</p><p class="elsevierStylePara">Watanabe S et al&#46; demonstrated that the patient had MPO-ANCA-associated glomerulonephritis superimposed on idiopathic membranous nephropathy in the coexistence of MGN and ANCA-associated glomerulonephritis&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">6</span></span>&#160;It is well recognized that ANCA-positive patient may develop ANCA-related crescentic glomerulonephritis&#59; however&#44; the immunopathogenesis of crescentic transformation in ANCA-negative patients with primary membranous nephropathy seemed to be more difficult to elucidate&#46; Whether there are some other undetected autoantibodies involved in the pathogenesis of MGN accompanied by ANCA-negative crescentic glomerulonephritis remains unclear&#46; Therefore&#44; further research is required to clarify the pathogenesis of this rare concomitance and investigate the optimum treatment regimes for it&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p>"
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Response to 'Comment on 'Membranous glomerulonephritis associated with mieloperoxidase antineutrophil cytoplasmic antibody-associated glomerulonephritis''
Guang-Yu Zhoua, Li-Rong Bib
a Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China,
b Department of Pathology, First Hospital of Jilin University, Changchun, Jilin Province, China,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">We were very interested by the comment submitted by Dr&#46; Gioacchino Li Cavoli and his collaborators&#44; regarding their similar experience of a membranous glomerulonephritis with crescentic overlap&#46; First of all&#44; we would like to thank them for their input&#46;</p><p class="elsevierStylePara">They reported a case of membranous glomerulonephritis &#40;MGN&#41; with crescentic transformation in a ANCA-negative vasculitis which revealed no evidence of systemic lupus erythematosus &#40;SLE&#41;&#44; anti-glomerular basement membrane &#40;GBM&#41; glomerulonephritis&#44; infection&#44; malignancy and showed no improvement after immunosuppressive treatments&#46; The case they presented was similar to the patient that Kwan JT et al&#46; described previously&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">1</span></span>&#160;Although several authors have demonstrated the concomitance of MGN and ANCA-associated glomerulonephritis&#44;<span class="elsevierStyleSup"><span class="elsevierStyleSup">2-6</span></span>&#160;MGN accompanied by ANCA-negative crescentic glomerulonephritis has been rarely encountered&#46;</p><p class="elsevierStylePara">The light microscopic visualization of renal tissue in their case showed the formation of 11 crescents &#40;3 cellular crescents&#44; 1 fibrocellular crescent and 7 fibrotic crescents&#41; and 11 out of 17 glomeruli were globally sclerotic&#46; These histopathological changes indicate the patient has reached to an advanced stage of crescentic glomerulonephritis and the renal disease has progressed to the sclerotic phase at the time of renal biopsy&#46; Nasr SH et al&#46; reported that the percentage of globally sclerotic glomeruli correlated with nonresponse to immunosuppressive agents&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">5</span></span>&#160;This is why the patient showed no improvement after treated with steroid plus cyclophosphamide and started chronic haemodialysis treatment eventually&#46; By contrast&#44; our case showed 2 sclerosed glomeruli out of 19 glomeruli&#44; the formation of 9 crescents including 4 cellular crescents and 5 fibrocellular crescents&#44; as well as the fibrinoid necrosis lesions upon light microscopy&#46; This indicates our patient might be at the relatively early stage of crescentic glomerulonephritis and the renal biopsy findings may interpret the better response to immunosuppressive treatments in our case&#46;</p><p class="elsevierStylePara">Concerning the prognosis of this group of patients&#44; Nasr SH et al&#46; reported that 50&#37; of patients had reached endpoints of end-stage renal stage &#40;ESRD&#41; or death whether or not treated with immunosuppressive agents and the only independent predictor of progression to ESRD was serum creatinine at biopsy&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">5</span></span>&#160;However&#44; the different outcomes of the two cases we and Dr&#46; Gioacchino Li Cavoli exhibited reveal that the histological finding is more reliable to predict the prognosis&#46; As Dr&#46; Gioacchino Li Cavoli mentioned in the comment&#44; the importance of recognizing the patients with membranous nephropathy and crescentic glomerulonephritis at early stage of the disease is that early immunosuppressive treatment may ameliorate the progression of renal damage and may contribute to the useful recovery of renal function&#46;</p><p class="elsevierStylePara">Watanabe S et al&#46; demonstrated that the patient had MPO-ANCA-associated glomerulonephritis superimposed on idiopathic membranous nephropathy in the coexistence of MGN and ANCA-associated glomerulonephritis&#46;<span class="elsevierStyleSup"><span class="elsevierStyleSup">6</span></span>&#160;It is well recognized that ANCA-positive patient may develop ANCA-related crescentic glomerulonephritis&#59; however&#44; the immunopathogenesis of crescentic transformation in ANCA-negative patients with primary membranous nephropathy seemed to be more difficult to elucidate&#46; Whether there are some other undetected autoantibodies involved in the pathogenesis of MGN accompanied by ANCA-negative crescentic glomerulonephritis remains unclear&#46; Therefore&#44; further research is required to clarify the pathogenesis of this rare concomitance and investigate the optimum treatment regimes for it&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p>"
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Article information
ISSN: 20132514
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2022 January 25 31 56
2021 December 30 30 60
2021 November 27 28 55
2021 October 28 41 69
2021 September 36 34 70
2021 August 22 37 59
2021 July 26 32 58
2021 June 15 19 34
2021 May 24 27 51
2021 April 40 46 86
2021 March 35 27 62
2021 February 18 7 25
2021 January 24 16 40
2020 December 22 16 38
2020 November 23 8 31
2020 October 16 14 30
2020 September 11 5 16
2020 August 32 10 42
2020 July 14 9 23
2020 June 18 13 31
2020 May 17 11 28
2020 April 19 15 34
2020 March 24 16 40
2020 February 22 18 40
2020 January 23 21 44
2019 December 28 24 52
2019 November 21 14 35
2019 October 12 9 21
2019 September 19 20 39
2019 August 12 9 21
2019 July 19 17 36
2019 June 25 14 39
2019 May 15 30 45
2019 April 27 25 52
2019 March 23 17 40
2019 February 19 10 29
2019 January 32 17 49
2018 December 73 38 111
2018 November 117 21 138
2018 October 83 16 99
2018 September 57 9 66
2018 August 44 20 64
2018 July 44 16 60
2018 June 54 15 69
2018 May 63 18 81
2018 April 63 8 71
2018 March 44 5 49
2018 February 64 6 70
2018 January 63 5 68
2017 December 61 13 74
2017 November 35 5 40
2017 October 26 8 34
2017 September 32 8 40
2017 August 24 7 31
2017 July 27 10 37
2017 June 27 21 48
2017 May 30 18 48
2017 April 32 25 57
2017 March 17 30 47
2017 February 20 15 35
2017 January 13 10 23
2016 December 24 1 25
2016 November 34 7 41
2016 October 31 1 32
2016 September 61 2 63
2016 August 91 3 94
2016 July 102 6 108
2016 June 76 0 76
2016 May 80 0 80
2016 April 62 0 62
2016 March 43 0 43
2016 February 61 0 61
2016 January 61 0 61
2015 December 92 0 92
2015 November 70 0 70
2015 October 79 0 79
2015 September 48 0 48
2015 August 56 0 56
2015 July 37 0 37
2015 June 39 0 39
2015 May 34 0 34
2015 April 5 0 5
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