title: Anti-glomerular basement membrane disease superimposed on membranous nephropathy: a case report and review of the literature.
abstract: BACKGROUND
  Anti-glomerular basement membrane disease is a rare autoimmune disorder characterized by pulmonary hemorrhage, crescentic glomerulonephritis and the presence of circulating anti-glomerular basement membrane antibodies. The simultaneous occurrence of both anti-glomerular basement membrane disease and membranous nephropathy is rare.
  
  
  METHODS
  A 59-year-old Hispanic man presented with acute onset of nausea and vomiting and was found to have renal insufficiency. Work-up included a kidney biopsy, which revealed anti-glomerular basement membrane disease with underlying membranous nephropathy. He was treated with emergent hemodialysis, intravenous corticosteroids, plasmapheresis, and cyclophosphamide without improvement in his renal function.
  
  
  CONCLUSIONS
  Simultaneous anti-glomerular basement membrane disease and membranous nephropathy is very rare. There have been 16 previous case reports in the English language literature that have been associated with a high mortality and morbidity, and a very high rate of renal failure resulting in hemodialysis. Co-existence of membranous nephropathy and anti-glomerular basement membrane disease may be immune-mediated, although the exact mechanism is not clear.
authors.affiliation: Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA. atunkel@sbhcs.com.
authors.forename: Dhruval
authors.initials: D
authors.lastname: Patel
authors.forename: Noel
authors.initials: N
authors.lastname: Nivera
authors.forename: Allan R
authors.initials: AR
authors.lastname: Tunkel