Sequential development of pulmonary hemorrhage with MPO-ANCA complicating anti-glomerular basement membrane antibody-mediated glomerulonephritis.
We report a case of rapidly progressive glomerulonephritis caused by anti-glomerular basement membrane (anti-GBM) antibodies that progressed to end-stage renal disease in a 67-year-old woman with diabetes. Intensive combined immunosuppressive therapy with methylprednisolone bolus, oral prednisone, and cyclophosphamide led to negativity of anti-GBM antibodies but was not able to restore renal function. After 28 months of hemodialysis, the patient suddenly presented with pulmonary hemorrhage. In this setting, high levels of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) and negative anti-GBM antibodies were found. Therapy with oral prednisone and cyclophosphamide led to resolution of pulmonary hemorrhage and negativity of MPO-ANCA.
Peces
R
R
Services of Nephrology and Pathology, Hospital Central de Asturias, Oviedo, Spain. txrena@hca.es
Rodríguez
M
M
Pobes
A
A
Seco
M
M
D000368:Aged; D019867:Anti-Glomerular Basement Membrane Disease / Q000097:blood / Q000150:complications*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000209:etiology*; D006801:Humans; D008171:Lung Diseases / Q000097:blood / Q000209:etiology*; D009195:Peroxidase / Q000276:immunology
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D009195:Peroxidase