title: Presence of Anti-Glomerular Basement Membrane Antibodies and Myeloperoxidase Anti-Neutrophilic Cytoplasmic Antibodies in a Case of Rapidly Progressive Glomerulonephritis.
abstract: A 69-year-old male had initially presented with low-grade proteinuria, microhematuria, and a positive myeloperoxidase anti-neutrophilic antibody (ANCA). He subsequently developed deterioration of kidney function and developed uremic symptoms. Creatinine was 486.2 μmol/L (5.5 mg/dL). Anti-MPO was positive (titer >8 U, normal <0.4). He was clinically diagnosed with rapidly proliferative glomerulonephritis most likely due to ANCA vasculitis. He received three doses of pulse methylprednisolone therapy. Kidney biopsy showed pauci-immune glomerulonephritis. Immunofluorescence was positive for faint linear IgG staining of glomerular basement membrane (GBM). Anti-GBM antibody was positive 2.1 U (normal <1). He was started on high-dose oral steroids; monthly intravenous cyclophosphamide and plasmapheresis were also initiated. His symptoms improved and creatinine is 247.5 μmol/L (2.8 mg/dL). His repeat anti-GBM antibody was negative. This is a rare case of rapidly progressive glomerulonephritis due to dual MPO-ANCA antibodies and anti-GBM antibodies (DAV).
authors: Division of Nephrology, Department of Medicine, Lenox Hill Hospital , New York, NY , USA.
authors: Gaurang P
authors: GP
authors: Mavani
authors: Division of Nephrology, Department of Medicine, Lenox Hill Hospital , New York, NY , USA.
authors: Max
authors: M
authors: Pommier
authors: Division of Nephrology, Department of Medicine, Lenox Hill Hospital , New York, NY , USA.
authors: Sandar
authors: S
authors: Win
authors: Division of Nephrology, Department of Medicine, Lenox Hill Hospital , New York, NY , USA.
authors: Michael F
authors: MF
authors: Michelis
authors: Division of Nephrology, Department of Medicine, Lenox Hill Hospital , New York, NY , USA.
authors: Jordan
authors: J
authors: Rosenstock
keywords: RPGN; anti-GBM antibody; anti-MPO antibody; cyclophosphamide; plasmapheresis