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Nephrotic syndrome due to minimal-change disease superimposed on anti-glomerular basement membrane antibody positive glomerulonephritis; a case report.
- Source :
-
BMC nephrology [BMC Nephrol] 2020 Jul 17; Vol. 21 (1), pp. 283. Date of Electronic Publication: 2020 Jul 17. - Publication Year :
- 2020
-
Abstract
- Background: The prognosis for renal function in anti-GBM glomerulonephritis (anti-GBM GN) is extremely poor, and when renal impairment progresses severely, it is difficult to expect improvement. In addition, it is also known that once the disease activity can be controlled by aggressive treatment, its recurrence is rare. We experienced an anti-GBM GN that improved from severe renal dysfunction and relapsed. A possible cause was the superimpose of nephrotic syndrome due to minimal change disease (MCD).<br />Case Presentation: A 30-year-old man was admitted to our hospital because of general malaise, fever, oliguria and renal dysfunction. The patient's laboratory data showed serum creatinine as high as 6.6 mg/dl, and severe inflammation (C-reactive protein 20.6 mg/dl). Anti-glomerular basement membrane antibody (anti-GBM Ab) was detected in his serum, which led to the diagnosis of anti-GBM GN. Treatment was initiated with high-dose glucocorticoid (GC) and plasma exchange therapy (PE), and the patient's renal function and oliguria improved rapidly and he was discharged 40 days after admission. Renal biopsy findings showed cellular crescents associated with linear IgG depositions along the glomerular tufts compatible with anti-GBM GN, but only about one-third of the glomeruli was involved, suggesting that it still remains an early stage of the disease. However, 2 months after discharge, he had a relapse and was readmitted due to severe proteinuria with positive anti-GBM Ab. On the second admission, after high-dose GC and PE combined with intravenous cyclophosphamide, and remission was achieved. Despite the relatively minor renal biopsy findings, the patient showed rapid renal dysfunction and relatively rapid improvement with our treatment. Electron microscopy of the renal biopsy tissue showed significant foot process effacement on podocytes in the apparently normal glomeruli, without electron dense deposits.<br />Conclusion: On the basis of clinical course and renal pathology, it is suggested that the present case was a rare complication of an early stage of anti-GBM GN and minimal change nephrotic syndrome. Although the simultaneous development of anti-GBM GN and MCD with anti-GBM antibody is unclear, it might have been precipitated by influenza infection or some unknown factor.
- Subjects :
- Adult
Anti-Glomerular Basement Membrane Disease complications
Anti-Glomerular Basement Membrane Disease immunology
Anti-Glomerular Basement Membrane Disease therapy
Autoantibodies immunology
Cyclophosphamide therapeutic use
Glucocorticoids therapeutic use
Humans
Immunosuppressive Agents therapeutic use
Male
Microscopy, Electron
Nephrosis, Lipoid complications
Nephrosis, Lipoid therapy
Nephrotic Syndrome complications
Nephrotic Syndrome therapy
Plasma Exchange
Recurrence
Anti-Glomerular Basement Membrane Disease pathology
Kidney Glomerulus ultrastructure
Nephrosis, Lipoid pathology
Nephrotic Syndrome pathology
Podocytes ultrastructure
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2369
- Volume :
- 21
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 32680573
- Full Text :
- https://doi.org/10.1186/s12882-020-01947-x