Neutrophil contribution to the crescentic glomerulonephritis in SCG / Kj mice. (2004 Jun)
neutrophil contribution to the crescentic glomerulonephritis in SCG / Kj mice . background : myeloperoxidase specific anti neutrophil cytoplasmic auto antibody ( MPO ANCA ) has been a useful diagnostic marker in systemic vasculitis with crescentic glomerulonephritis ( CrGN ) . It is highly suspected that the antigenic enzyme MPO released from activated neutrophils is involved in these lesions . We evaluated the relationship between neutrophil functions including peripheral neutrophil counts and renal lesions in SCG / Kj mice as a model of ANCA associated CrGN and vasculitis . methods : peripheral neutrophil counts , the plasma levels of MPO ANCA and tumour necrosis factor alpha ( TNF alpha ) were measured . The capacity of MPO release and superoxide generation were evaluated as neutrophil activity . The renal lesions were estimated by grade of proteinuria , histopathological lesion , such as glomerular neutrophil infiltration and active or chronic renal injury scores with crescent formation . results : MPO ANCA and TNF alpha levels were higher than those of normal mice c57bl / 6 even before overt proteinuria ; subsequently , peripheral neutrophils increased . In the phase of nephritis with low grade proteinuria , the spontaneous release of MPO from peripheral neutrophils increased , while superoxide generation increased before spontaneous MPO release occurred . In addition , the renal lesion in histological observations was aggravated with ageing and the glomerular neutrophil infiltration was positively correlated with MPO ANCA levels , as well as with histological indices of nephritis , …

Antineutrophil cytoplasmic autoantibodies in poststreptococcal nephritis. (1994 Mar)
antineutrophil cytoplasmic autoantibodies in poststreptococcal nephritis . Sera from 210 patients with apsgn , were tested for the presence of ANCA ( IgG isotype ) . indirect immunofluorescence ( IF ) on ethanol fixed human PMNs was used , and for those positive sera , elisa kits for PR3 ( proteinase 3 ) and MPO ( myeloperoxidase ) was performed . ANCA were detected in 9 ( 18 out of 210 cases ) in a predominantly diffuse cytoplasmic staining pattern in 14 cases ( 77 ) , and in a perinuclear pattern in the remaining 4 cases ( 22 ) . Anti MPO was found in 4 cases ( C ANCA 3 ; P ANCA 1 ) and anti PR3 was always negative . The presence of ANCA was significantly associated with a more severe glomerular disease as assessed by the serum creatinine value and the crescents formation . longitudinal studies performed in 11 cases have shown that raised levels of these autoantibodies may persist for at least six months , without relationship with disease activity . further studies are required to dilucidate the specificity of these autoantibodies , and if its presence is either an epiphenomenon of the heterogeneous humoral immune response in streptococcal infection , or they play some pathogenic role in apsgn .

A case of progressive systemic sclerosis with crescentic glomerulonephritis associated with myeloperoxidase antineutrophil cytoplasmic antibody ( MPO ANCA ) and … (1995 May)
A case of progressive systemic sclerosis with crescentic glomerulonephritis associated with myeloperoxidase antineutrophil cytoplasmic antibody ( MPO ANCA ) and anti glomerular basement membrane antibody ( anti GBM Ab ) A 42 year old female with progressive systemic sclerosis ( PSS ) developed rapidly progressive renal insufficiency . renal pathology revealed crescentic glomerulonephritis ( CrGN ) without mucoid intimal proliferation of the interlobular arteries and fibrinoid necrosis of the afferent arterioles . immunofluorescent micrography showed linear deposition of IgG along the glomerular capillary wall . Not only anti glomerular basement membrane antibody ( anti GBM Ab ) , but also myeloperoxidase antineutrophil cytoplasmic antibody ( MPO ANCA ) were simultaneously detected by an enzymelinked immunosorbent assay ( elisa ) . She did not develop pulmonary hemorrhage . these findings were compatible with ANCA related vasculitis and anti GBM Ab nephritis . laboratory findings showed rapid elevation of serum creatinine level ( over 6 . 0mg / dl ) , a high titer of MPO ANCA ( 660 . 7 elisa unit / ml ) and anti GBM Ab ( 409 units ) . therefore , she was started on methylprednisolone pulse therapy and temporary hemodialysis . after immunosuppressive therapy , both antibodies titers had fallen to within the normal range . however , end stage renal failure did not improve and maintenance hemodialysis was introduced . recently , six patients of PSS with MPO ANCA were first reported in japan . these autoantibodies detected in this case strongly suggested that …

Anti neutrophil cytoplasmic antibody MPO ANCA related with disease activity of vasculitis myeloperoxidase ( MPO ) specific anti neutrophil cytoplasmic … (2006 May)
Anti neutrophil cytoplasmic antibody MPO ANCA related with disease activity of vasculitis myeloperoxidase ( MPO ) specific anti neutrophil cytoplasmic antibodies ( MPO ANCA ) are involved in the development of vasculitis microscopic polyangiitis , a systemic vasculitis etc . We have showed a correlation of MPO ANCA epitopes in vasculitis concerning contribution of N and C terminus of MPO to severity of the diseases . On the other hand , a role of activated neutrophils in inflammatory nephritis renal lesions using SCG / Kj mice . In the phase of nephritis with a low grade of proteinuria , the spontaneous release of MPO from peripheral neutrophils increased , indicating that neutrophils are activated and contribute to the development of active crescentic lesions in SCG / Kj mice . In addition , we have investigated that mice having CADS / CAWS induced vasculitis also are good model animals for the analysis of the production of MPO ANCA . furthermore , we have clarified that MPO is a major antigen for MPO ANCA production using MPO knock mice .

A pediatric occurrence of crescentic glomerulonephritis associated with antineutrophil cytoplasmic antibodies and mesangial IgA deposits. (2007 Aug)
A pediatric occurrence of crescentic glomerulonephritis associated with antineutrophil cytoplasmic antibodies and mesangial IgA deposits . antineutrophil cytoplasmic antibody ( ANCA ) associated glomerulonephritis usually shows histopathologic features of pauciimmune crescentic glomerulonephritis and occurs late in life . We report a 14 year old japanese girl presenting with proteinuria , hematuria and mildly elevated serum creatinine . A renal biopsy specimen demonstrated crescentic glomerulonephritis , immunofluorescence showed mesangial IgA staining . electron microscopic examination disclosed paramesangial deposits . serum ANCA against myeloperoxidase ( MPO ) were detected at high titers . myeloperoxidase ANCA related nephritis accompanied by IgA nephropathy is considered rare in childhood and teen years . Yet , if ANCA assays and detailed electron microscopic examination of renal specimens were performed routinely in patients with rapidly progressive glomerulonephritis , the diagnosis might be more frequent in young patients .

Autoantibodies to myeloperoxidase in idiopathic and drug induced systemic lupus erythematosus and vasculitis. (1994 May)
autoantibodies to myeloperoxidase in idiopathic and drug induced systemic lupus erythematosus and vasculitis . circulating antibodies to myeloperoxidase ( MPO ) have been described in a variety of vasculitic syndromes , drug induced SLE and drug induced nephritis . We have examined the autoantibody profile in acute sera from patients with antineutrophil cytoplasmic antibody positive vasculitis ( n 8 ) , drug induced nephritis ( n 4 ) , drug induced lupus ( n 7 ) , SLE ( n 27 ) and nephritis associated with SLE ( n 17 ) . significant binding to purified MPO in elisa was given by all sera from patients with vasculitis and drug induced nephritis but ANA sought by indirect immunofluorescence on HEp 2 cells were not detected . Both anti MPO and ANA were found in sera from patients with drug induced lupus . Sera from patients with SLE or SLE nephritis did not contain high titres of anti MPO antibodies but invariably contained ANA . Anti MPO antibodies of both IgG and IgM classes were present in all sera from patients with drug induced disease . although the number of samples tested was small , sera from patients with drug induced nephritis showed significantly greater median binding of IgM to MPO compared with drug induced SLE . binding to MPO by IgG in these sera was not significantly different . these findings suggest that the mechanism of interaction between hydralazine and the immune system in the two drug induced autoimmune diseases …

Neutrophil fcgammariiib allelic polymorphism in anti neutrophil cytoplasmic antibody ( ANCA ) positive systemic vasculitis. (2000 Apr)
neutrophil fcgammariiib allelic polymorphism in anti neutrophil cytoplasmic antibody ( ANCA ) positive systemic vasculitis . neutrophils constitutively express fcgammariia and fcgammariiib receptors . Both receptors exhibit allelic variants which have different quantitative functional capacities : the biallelic fcgammariia R131 and H131 alleles , and the neutrophil antigen ( NA ) NA1 / NA2 alleles . ANCA activation of neutrophils requires ligation of fcgammariia receptor , but recent data have shown that ANCA can also bind fcgammariiib receptor . The aim of this study was to determine whether the fcgammariiib polymorphism was a risk factor for the development of ANCA associated systemic vasculitis , or the associated nephritis . fcgammariiib receptor genotyping was determined by allele specific polymerase chain reaction . genomic DNA was extracted from 101 caucasian patients with ANCA vasculitis ( of whom 84 had renal disease ) and 100 ethnically matched controls . Of the patients with ANCA systemic vasculitis , 71 had ANCA with specificity for proteinase 3 and 30 with specificity for myeloperoxidase ( MPO ) . overall no significant difference in genotype distribution or allele frequencies was found between patients and controls , or between patients with renal disease and controls . however , there was a trend for an increase in homozygosity for the NA1 allele in patients with a vasculitis and this was significant in patients who had anti MPO antibodies . The fcgammariiib receptor polymorphism is not a major factor predisposing to the development of ANCA systemic vasculitis or the associated …

A case of anti glomerular basement membrane antibody ( agbma ) nephritis associated with myeloperoxidase antineutrophil cytoplasmic antibody ( MPO … (1994 Oct)
A case of anti glomerular basement membrane antibody ( agbma ) nephritis associated with myeloperoxidase antineutrophil cytoplasmic antibody ( MPO ANCA ) A 68 year old patient visited our hospital , because of progressive renal failure . laboratory data were serum creatinine 13 . 3 mg / dl , BUN 74 . 3 mg / dl , agbma 134U , MPO ANCA 37 and CIC 1 . 6 g / dl . hemodialysis was performed on admission and renal biopsy was conducted . though the histological findings showed fibrocellular crescents and global sclerosis in many glomeruli , renal function was gradually ameliorated by administration of prednisolone ( 40 mg / day ) and cyclophosphamide ( 50 mg / day ) . after 3 weeks of therapy , hemodialysis was withdrawn temporarily . because of the complication of pneumocystis carini , prednisolone and cyclophosphamide were discontinued , and maintenance hemodialysis was resumed . In spite of progressed histological findings , hemodialysis was withdrawn at least temporarily through the use of pharmacological therapy . Thus , the presence of ANCA may indicate a relatively good prognosis of agbma nephritis .

ANCA GBM dot blot : evaluation of an assay in the differential diagnosis of patients presenting with rapidly progressive glomerulonephritis. (2004 May)
ANCA GBM dot blot : evaluation of an assay in the differential diagnosis of patients presenting with rapidly progressive glomerulonephritis . rapidly progressive glomerulonephritis ( RPGN ) is characterized by rapid and progressive loss of renal function and the presence of crescentic glomerulonephritis ( CGN ) . early diagnosis and appropriate treatment is mandatory to prevent death and / or renal failure . We have evaluated an ANCA GBM dot blot diagnostic test in terms of sensitivity , specificity , and inter observer effect in consecutive patients with RPGN ( n 82 ) . control sera ( n 34 ) included healthy and relevant disease controls . Dot blots were independently evaluated by nine observers . proteinase 3 ( PR3 ) ANCA , myeloperoxidase ( MPO ) ANCA , and both were detected by elisa in 36 , 32 , and 3 samples of 71 patients with pauci immune CGN , respectively . Two additional samples were ANCA negative . The dot blot revealed a sensitivity of 92 95 for PR3 ANCA and 80 86 for MPO ANCA . The specificity of the dot blot for PR3 and MPO ANCA was 100 . In the patients with anti GBM nephritis ( n 9 ) anti GBM was detected by both elisa and dot blot ( sensitivity : 100 ) . The specificity of the anti GBM dot blot was 91 94 . however , the inter observer effect was relatively high for detection of anti GBM antibodies ( 24 ) …

Contribution of myeloperoxidase in vasculitis development. (2004 Oct)
contribution of myeloperoxidase in vasculitis development . infiltrated neutrophils is believed to contribute to the progression of vasculitis . In particular , myeloperoxidase ( MPO ) specific antibodies against neutrophils , anti neutrophil cytoplasmic antibodies ( MPO ANCA ) is involved in the development of vasculitis microscopic polyangiitis etc . In japan a higher percentage of MPO ANCA than that in europe has been reported In addition , we showed a correlation of MPO ANCA epitopes of kawasaki disease patients by 47 with that of mothers . On the other hand , mice having CADS / CAWS induced vasculitis is a good model for the analysis of the production of MPO ANCA . We have clarified that MPO is a major antigen for MPO ANCA production using MPO KO mice . We also investigated the role of activated neutrophils in nephritis renal lesions using SCG / Kj mice . In the phase of nephritis with low grade of proteinuria , the spontaneous release of MPO from peripheral neutrophils increased , indicating that neutrophils are activated and contribute to the development of active crescentic lesion in SCG / Kj mice .

Anti neutrophil cytoplasmic antibodies ( ANCA ) in systemic lupus erythematosus : prevalence , clinical associations and correlation with other … (2005 Jan)
Anti neutrophil cytoplasmic antibodies ( ANCA ) in systemic lupus erythematosus : prevalence , clinical associations and correlation with other autoantibodies . AIM : This study was undertaken to clarify the nature of anti neutrophil cytoplasmic antibodies ( ANCA ) along with other autoantibodies in lupus nephritis ( LN ) patients and in systemic lupus erythematosus ( SLE ) patients without nephritis and to know their correlation with clinical manifestations and presence of other autoantibodies . material AND methods : fourty one LN patients and 18 SLE patients without nephritis were studied . LN patients were subdivided into diffuse proliferative glomerulonephritis ( DPGN ) , focal proliferative glomerulonephritis ( FPGN ) , rapidly progressive glomerulonephritis ( RPGN ) and membranoproliferative glomerulonephritis ( MPGN ) . Anti neutrophil cytoplasmic antibodies ( ANCA ) were detected by indirect immunofluorescence and confocal laser scanning microscope using PMN and HL60 cells . ANCA specificities like anti myeloperoxidase ( anti MPO ) , anti proteinase 3 ( anti PR3 ) , anti lactoferrin ( anti LF ) and anti cathepsin G ( anti CG ) were detected by elisa . other autoantibodies like anti nuclear antibodies ( ANA ) , anti double stranded DNA ( anti dsdna ) , anti single stranded DNA ( anti ssdna ) , anti ribonucleoproteins ( anti nRNP ) , anti smith antibodies ( anti Sm ) and rheumatoid factor ( RF ) were also tested . results : ANCA was detected in 37 . 3 patients . The predominant …

Properties of circulating IgA molecules in henoch schönlein purpura nephritis with focus on neutrophil cytoplasmic antigen IgA binding ( IgA … (1998 Jan)
properties of circulating IgA molecules in henoch schönlein purpura nephritis with focus on neutrophil cytoplasmic antigen IgA binding ( IgA ANCA ) : new insight into a debated issue . italian group of renal immunopathology collaborative study on henoch schönlein purpura in adults and in children . background : The presence and the pathogenetic role of circulating IgA reacting with neutrophil cytoplasmic antigens ( IgA ANCA ) in patients with henoch schönlein purpura ( HSP ) is still debated . This study was aimed to investigate some characteristics of serum IgA and macromolecular IgA in HSP patients , focusing on IgA ANCA . methods : eighty seven HSP patients with biopsy proved renal involvement ( 51 adults and 36 children ) enrolled in a multicentre study of the italian group of immunopathology were investigated . results : significantly high levels of IgA immune complexes were found in both adults ( P 0 . 05 ) and children ( P 0 . 01 ) , while the binding of IgA to jacalin , was significantly low in children with HSP ( P 0 . 01 ) only . Two series of elisa were done for IgA ANCA , in two different laboratories . increased binding to PMN crude extracts ( P 0 . 01 ) without any modification in IgA binding to proteinase 3 was found by either specific elisa . conversely , the binding of IgA to myeloperoxidase ( MPO ) was found to be significantly ( P 0 . …

Pantoprazole and perinuclear antineutrophil cytoplasmic antibody associated vasculitis. (2006 Mar)
pantoprazole and perinuclear antineutrophil cytoplasmic antibody associated vasculitis . systemic vasculitis may , at times , be drug induced and associated with antineutrophil cytoplasmic antibodies ( ANCA ) . however , pantoprazole , a commonly used and well tolerated proton pump inhibitor , has not previously been reported to cause ANCA associated syndromes . We describe a patient who developed interstitial nephritis , cutaneous vasculitis , a perinuclear ANCA staining pattern ( panca ) on immunofluorescence , and anti myeloperoxidase antibodies ( MPO ANCA ) in association with pantoprazole . We review various immune mediated syndromes reported in association with proton pump inhibitors , including one report of omeprazole associated with interstitial nephritis and the development of ANCA .

Anti MPO small vessel vasculitis causing prostatis and nephritis. (2007 Jun)
Anti MPO small vessel vasculitis causing prostatis and nephritis . microscopic polyangiitis is a necrotizing angiitis involving capillaries , venules , and arterioles . The vascular beds of various organs may be involved , causing varying presentations . To our knowledge , this is the first case of anti myeloperoxidase ( anti MPO ) antibody small vessel vasculitis causing prostatic vasculitis . A 79 year old nonsmoker american man presented with symptoms of fevers , malaise , weight loss , and cough . urine analysis revealed hematuria . blood tests were remarkable for an elevated prostate specific antigen ( PSA ) and a serum creatinine of 3 . 1 mg / dl ( baseline , 1 . 2 mg / dl ) . computed tomography ( CT ) scan of the thorax revealed a 4 . 7 cm mass in the left lower lobe of the lung . metastatic prostate cancer was suspected . therefore , prostatic biopsy was performed . The biopsy revealed fibrinoid degeneration with vasculitic changes involving the arterioles . When evaluated by nephrology , his serum creatinine was 9 . 9 mg / dl . A renal biopsy was performed , which revealed focal segmental necrotizing glomerulopathy with microscopic vasculitis . All the serologies were normal , with the exception of low C4 , and positive perinuclear antineutrophil cytoplasmic antibodies ( ANCA ) associated with anti MPO . The patient was started on intermittent hemodialysis , steroids , and oral cytoxan . despite treatment , with …

Autoantibodies to leucocyte antigens in hydralazine associated nephritis. (1992 Feb)
autoantibodies to leucocyte antigens in hydralazine associated nephritis . clinical and laboratory findings and drug history were studied in 17 patients with suspected hydralazine associated nephritis , five of whom only had renal disease , while twelve also had extrarenal manifestations . renal biopsies revealed extracapillary proliferative or focal segmental proliferative glomerulonephritis in 10 patients , and tubulo interstitial nephritis in five patients . antinuclear antibody ( ANA ) was found in 16 patients , but none of the 14 patients tested had antibodies to DNA . tests for antibodies to myeloperoxidase ( anti MPO ) and antibodies to neutrophil cytoplasm antigen ( ANCA ) were performed by elisa . twelve of the 14 patients tested had anti MPO ; five of these 14 patients had ANCA , while one had borderline levels . these findings suggest that hydralazine facilitates the induction of a systemic disease with multiple autoantibody production .

Endothelium myeloperoxidase antimyeloperoxidase interaction in vasculitis. (1993 Feb)
endothelium myeloperoxidase antimyeloperoxidase interaction in vasculitis . antibodies to myeloperoxidase ( MPO ) are found in the sera of patients with microscopic polyarteritis and idiopathic crescentic glomerulonephritis . their pathogenicity is unknown . studies were carried out on the binding of MPO to cultured human umbilical vein endothelial cells and the recognition of endothelium bound MPO by antibody to MPO . endothelial cells were cultured from human umbilical veins . The binding of MPO to endothelial cells and its inhibition by poly D lysine was detected using a monoclonal antibody to MPO and direct staining with apaap and also by an enzyme linked immunoassay ( elisa ) . The binding of anti MPO antibody in the sera of patients with microscopic polyarteritis to endothelium coated MPO was detected by elisa . MPO bound to endothelial cells both on direct staining and elisa and this binding was inhibited by the polycation poly D lysine , suggesting that it was charge mediated . binding of anti MPO antibody in the sera of patients with microscopic polyarteritis to endothelium coated MPO was significantly higher than the binding of sera from normal subjects ( P 0 . 04 ) , patients with idiopathic glomerulonephritis ( P 0 . 0005 ) , and patients with lupus nephritis ( P 0 . 009 ) . MPO binds to cultured human umbilical vein endothelium probably by a charge mechanism , and can react with anti MPO antibodies in the sera of patients with microscopic polyarteritis as well …

Association of the G 463A myeloperoxidase gene polymorphism with renal disease in african americans with systemic lupus erythematosus. (2007 Oct)
association of the G 463A myeloperoxidase gene polymorphism with renal disease in african americans with systemic lupus erythematosus . objective : myeloperoxidase ( MPO ) is an enzyme expressed in neutrophils that is involved in tissue damage in inflammatory renal diseases . A functional G to A single nucleotide polymorphism ( SNP ) is present at position 463 of the MPO promoter region and is associated with altered MPO expression . We hypothesized that the G 463A MPO SNP is a risk factor for developing lupus nephritis ( LN ) due to its potential influence on the inflammatory response . methods : DNA from 229 patients with SLE and 277 controls from the carolina lupus cohort , 58 african american patients from the Sea island lupus cohort , and 51 african american patients from the lupus multiplex registry and repository were genotyped by PCR . A linear regression model was used to examine relationships between the MPO genotype , case / control status , demographic characteristics , and LN . results : there was no association of MPO genotype with systemic lupus erythematosus ( SLE ) . however , the odds of developing LN were significantly higher among those with an A allele , compared to those without , in african american cases of all 3 cohorts . When the likelihood of developing LN was compared across MPO genotypes , the risk of developing LN was significantly higher among cases with a GA genotype versus GG ( OR 2 . …

Four cases of anti myeloperoxidase antibody related rapidly progressive glomerulonephritis during the course of idiopathic pulmonary fibrosis. (2001 Apr)
Four cases of anti myeloperoxidase antibody related rapidly progressive glomerulonephritis during the course of idiopathic pulmonary fibrosis . We report here 4 cases of rapidly progressive glomerulonephritis ( RPGN ) which developed during the management of idiopathic pulmonary fibrosis . In each patient , pulmonary disease preceded the onset of nephritis by 1 to 6 years . All patients had a high titer of serum autoantibodies against myeloperoxidase ( MPO ANCA ) when the diagnosis of RPGN was made . although the association of pulmonary fibrosis with ANCA related glomerulonephritis has been occasionally described in the past literature , the sequence of pulmonary and renal injury has not been well defined . The present report demonstrates that idiopathic pulmonary fibrosis exists as a preceding condition in some patients with MPO ANCA related nephritis .

Aggravation of rat nephrotoxic serum nephritis by anti myeloperoxidase antibodies. (1995 May)
aggravation of rat nephrotoxic serum nephritis by anti myeloperoxidase antibodies . To investigate a possible role of anti neutrophil cytoplasmic antibodies directed against myeloperoxidase ( MPO ANCA ) in glomerulonephritis , we prepared anti rat MPO antiserum by immunization of rat MPO into a rabbit . Then we administered anti rat MPO antiserum ( group 1 ) or normal rabbit serum ( NRS ) ( group 2 ) into rats before injection of nephrotoxic serum ( NTS ) , which induced nephrotoxic serum nephritis ( NTN ) . other groups of rats received either anti rat MPO anti serum ( group 3 ) or NRS ( group 4 ) before injection of NRS but not NTS . Rats in group 1 and group 2 were sacrificed at either 3 hours , 15 hours , or 14 days after NTS injection . Rats in group 3 and group 4 were sacrificed at 15 hours after the last NRS injection . By light microscopy , in rats with NTN sacrificed at 3 hours , counts of polymorphonuclear leukocytes ( PMN ) per glomerulus were 21 . 6 / 3 . 5 in group 1 and 8 . 4 / 1 . 7 in group 2 ( P 0 . 01 ) . At 15 hours , massive glomerular fibrin deposits were observed in group 1 rats ( fibrin score , 131 / 8 ) , but not in group 2 rats ( fibrin score , 27 / 21 ; P 0 . …

Significantly high regional morbidity of MPO ANCA related angitis and / or nephritis with respiratory tract involvement after the 1995 … (2000 Jun)
significantly high regional morbidity of MPO ANCA related angitis and / or nephritis with respiratory tract involvement after the 1995 great earthquake in Kobe ( japan ) . within a 3 year period after the great earthquake of Kobe ( japan ) resulted in more than 6 , 000 deaths and complete destruction of the central area of Kobe City , 14 patients ( group 1 G1 ) with myeloperoxidase ( MPO ) antineutrophil cytoplasmic autoantibody ( ANCA ) related angitis and / or nephritis presented to nishi Kobe medical center in western Kobe City . On the other hand , only 15 patients with this disease were encountered between 1990 and 1997 at kyoto university hospital in kyoto City , which is located 80 km from Kobe City and was only minimally affected by the earthquake . these 15 patients and 1 patient who presented to nishi Kobe medical center before the great earthquake were classified as group 2 ( G2 ) . although the average MPO ANCA titer in G1 was almost the same as that in G2 , G1 showed a significantly greater average value for white blood cells than G2 ( 11 , 321 / 4 , 369 versus 8 , 116 / 2 , 389 / microl ; P 0 . 05 ) . concerning renal function , a significant elevation in creatinine ( Cr ) levels at diagnosis ( 7 . 4 / 3 . 8 versus 2 . 1 / 1 . 4 …