Membranous Glomerulonephritis With Crescents

Area of Science:

• Nephrology
• Immunopathology
• Glomerular Diseases

Background:

• Membranous glomerulonephritis (MGN) rarely co-occurs with necrotizing and crescentic glomerulonephritis (NCGN).
• This dual glomerulopathy is often associated with specific autoantibodies, including anti-neutrophil cytoplasm antibodies (ANCAs), anti-glomerular basement membrane (GBM) antibodies, and anti-phospholipase A2 receptor (PLA2R) antibodies.

Purpose of the Study:

• To report the clinical and pathological findings of patients with coexisting MGN and NCGN.
• To investigate the association of this rare condition with ANCA, anti-GBM, and anti-PLA2R antibodies.
• To analyze patient outcomes and treatment responses.

Main Methods:

• Retrospective analysis of 15 patients diagnosed with MGN and NCGN.
• Evaluation of clinical data, including autoantibody profiles (ANCA, anti-GBM, anti-PLA2R), urinalysis, and kidney biopsy findings.
• Assessment of treatment regimens (steroids, cyclophosphamide, rituximab) and patient follow-up data.

Main Results:

• The cohort (15 patients, median age 63) presented with heavy proteinuria and microscopic hematuria.
• MGN and NCGN were diagnosed concurrently in 12 patients; 7 had ANCA, 5 had anti-GBM, and 2 had anti-PLA2R antibodies.
• At median 72-month follow-up, 9 patients showed stabilized/improved renal function, 6 progressed to end-stage renal disease, and 4 died.

Conclusions:

• MGN with crescents associated with ANCAs or anti-GBM antibodies represents a rare dual glomerulopathy.
• Patients present with acute kidney injury, heavy proteinuria, and hematuria, requiring treatment for rapidly progressive glomerulonephritis.
• The prognosis is variable, with a significant proportion (40%) progressing to end-stage renal disease.