[Rapidly progressive glomerulonephritis in a 68-year-old man].
A 68-year-old male with macroscopic hematuria and constitutional symptoms as fever and weight loss. There was nothing interesting in the anamnesis or in the physical exploration. The laboratory test had an elevation of creatinine of 4 mg/dL and ten days before it had been 1.4 mg/dL. In the urine analysis: proteinuria of 1.5 G/24 h, and hematuria. On the second day we made a renal biopsy where we could seen segmental glomerular necrosis and crescent fromation in 80% of the glomeruli. In the immune study c-ANCA anti-PR3 was positive. In the complementary studies we didn't find other organs affected. With the diagnosis of pauci-immune glomerulonephritis limited to the kidney we began treatment with corticosteroids and cyclophosphamide. As the renal function was severely affected the patient needed one dialysis session. We began with 1 g intravenous methylprednisolone daily for 3 days followed by oral prednisone 60 mg daily tapering to 10 mg daily by 3 months. This was combined with 150 mg oral cyclophosphamide daily. Seven plasma exchanges were performed. At the beginning of treatment creatinine was 7 mg/dL, it was decreasing rapidly and three week after cretinine was 3 mg/Dl and he was asymptomatic. One year after treatment, creatinine is 1.4 mg/dL and the urine analysis is normal, C-ANCA are negative.
Rubio
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Servicio de Nefrología, Clínica Puerta de Hierro, Madrid.
Acevedo
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D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001324:Autoantigens / Q000276:immunology; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D001706:Biopsy; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000628:therapy; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D053146:Myeloblastin; D010951:Plasma Exchange; D011241:Prednisone / Q000627:therapeutic use; D012697:Serine Endopeptidases / Q000276:immunology; D014657:Vasculitis / Q000209:etiology / Q000276:immunology
D019268:Antibodies, Antineutrophil Cytoplasmic; D001324:Autoantigens; D003520:Cyclophosphamide; D012697:Serine Endopeptidases; D053146:Myeloblastin; D011241:Prednisone; D008775:Methylprednisolone