title: Concurrent anti-glomerular basement membrane disease and membranous glomerulonephritis: a case report and literature review.
abstract: BACKGROUND
  Anti-glomerular basement membrane disease (anti-GBM) is a relatively rare entity characterized by antibodies to collagen type IV of glomerular and alveolar basement membranes. The sequential or simultaneous presentation of anti-glomerular basement membrane disease with membranous glomerulonephritis has been infrequently described.
  
  
  METHODS
  We present the case of a 49-year-old man who had fatigue, flank pain, hematuria and renal failure. Serology was positive for anti-GBM antibodies; crescentic glomerulonephritis was seen on renal biopsy. Immunofluorescence and electron microscopy demonstrated evidence of both anti-GBM glomerulonephritis and membranous deposits.
  
  
  CONCLUSIONS
  Simultaneous anti-GBM disease and membranous glomerulonephritis is the most common temporal presentation of this rare entity. However, cases of membranous glomerulonephritis preceding or following recovery from anti-GBM disease have been described. Study of such cases provides insight into pathophysiologic mechanisms, including the possibility of increased antigen synthesis, exposure of cryptic epitopes, and/or capping and shedding of antigen-antibody complexes, in analogy to Heymann nephritis.
authors.affiliation: Department of Pathology, Stanford University Medical Center, Stanford, CA, USA. troxellm@ohsu.edu
authors.forename: M L
authors.initials: ML
authors.lastname: Troxell
authors.forename: A Bhatt
authors.initials: AB
authors.lastname: Saxena
authors.forename: N
authors.initials: N
authors.lastname: Kambham
mesh_terms: D019867:Anti-Glomerular Basement Membrane Disease / Q000150:complications* / Q000276:immunology / Q000473:pathology; D001323:Autoantibodies / Q000378:metabolism; D024141:Collagen Type IV / Q000276:immunology; D050533:Glomerular Basement Membrane / Q000276:immunology* / Q000473:pathology*; D015433:Glomerulonephritis, Membranous / Q000150:complications* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008297:Male; D008854:Microscopy, Electron; D008856:Microscopy, Fluorescence; D008875:Middle Aged
chemical_list: D001323:Autoantibodies; D024141:Collagen Type IV; D007074:Immunoglobulin G