title: A case of triple pathology: seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis and membranous nephropathy in a patient with underlying diabetic kidney disease.
abstract: In diabetic patients with acute kidney injury (AKI), kidney biopsy often reveals non-diabetic kidney pathology. This case describes a patient with known Type 1 diabetes who presented with AKI, nephrotic syndrome and haematuria. Combination pathology of seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis (anti-GBM GN), membranous nephropathy (MN) and diabetic nephropathy (DN) was demonstrated. Strong linear GBM IgG-staining on biopsy with crescentic GN and clinical AKI led to a diagnosis of anti-GBM GN, although serum antibodies were not detectable. Features of DN, Kimmelstiel-Wilson nodules and albumin staining were also present, along with features of MN, such as subepithelial deposits on electron microscopy. Despite treatment with immunosuppression and plasmapheresis, there was no recovery of kidney function. Coexisting anti-GBM GN and MN is well recognized, but the concurrent diagnosis with DN has not been described.
authors.affiliation: Department of Nephrology , St Vincent's Hospital , Fitzroy, VIC , Australia.
authors.forename: Sven-Jean
authors.initials: SJ
authors.lastname: Tan
authors.affiliation: Department of Nephrology , St Vincent's Hospital , Fitzroy, VIC , Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ducharlet
authors.affiliation: Department of Nephrology , St Vincent's Hospital , Fitzroy, VIC , Australia.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Dwyer
authors.affiliation: Department of Surgery and Orthopaedics , St Vincent's Hospital , Fitzroy, VIC , Australia.
authors.forename: Damian
authors.initials: D
authors.lastname: Myers
authors.affiliation: Department of Nephrology , St Vincent's Hospital , Fitzroy, VIC , Australia ; Department of Medicine , University of Melbourne , Parkville, VIC , Australia.
authors.forename: Robyn G
authors.initials: RG
authors.lastname: Langham
authors.affiliation: Department of Anatomical Pathology , St Vincent's Hospital , Fitzroy, VIC , Australia.
authors.forename: Prue A
authors.initials: PA
authors.lastname: Hill
keywords: anti-glomerular basement membrane (GBM) disease; diabetic nephropathy; membranous nephropathy; seronegative disease