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Published on: June 30, 2018
Diagnosis of membranous nephropathy with Anti-GBM glomerulonephritis: a case series report
Ge Liu1, Xinyan Feng1, Shuangyan Yu1
1Department of Nephrology, The Second Hospital, Dalian Medical University, 467 Zhongshan RoadLiao Ning, Dalian, 116000, China.
Background:
The concomitant occurrence of membranous nephropathy and anti-glomerular basement (anti-GBM) disease has been previously described but is extremely rare. However, delayed recognition or misdiagnosis leads to delayed treatment, resulting in worse renal and patient outcomes.
Case Presentation:
We present 3 patients with rapidly progressive glomerulonephritis (RPGN), anti-GBM and serum-positive M-type phospholipase A2 receptor (anti-PLA2R) antibody. Renal biopsies revealed PLA2R-associated membranous nephropathy with anti-GBM glomerulonephritis. We analyzed the clinical and pathological characteristics and discussed that the correct diagnosis of membranous nephropathy with anti-GBM should rely on a combination of renal biopsy findings and serological testing. Despite aggressive treatment, one patient received maintenance hemodialysis, one patient progressed to CKD 3 stage, and the other patient died of cerebral infarction.
Conclusion:
The simultaneous occurrence of membranous nephropathy and anti-GBM disease is extremely rare. The correct diagnosis of membranous nephropathy with anti-GBM relies on a combination of renal biopsy findings and serological testing. Early diagnosis is needed to improve the renal dysfunction.
Insights
Simultaneous membranous nephropathy and anti-glomerular basement (anti-GBM) disease is rare. Early diagnosis using renal biopsy and serological testing is crucial for improving kidney function and patient outcomes.
Area of Science:
- Nephrology
- Immunopathology
- Glomerular Diseases
Background:
- The co-occurrence of membranous nephropathy and anti-glomerular basement (anti-GBM) disease is exceptionally rare.
- Delayed diagnosis and treatment of this dual pathology can lead to adverse renal and patient outcomes.
Purpose of the Study:
- To present cases of patients with coexisting membranous nephropathy and anti-GBM disease.
- To emphasize the diagnostic challenges and the importance of integrated diagnostic approaches.
Main Methods:
- Analysis of clinical and pathological characteristics of three patients diagnosed with rapidly progressive glomerulonephritis (RPGN).
- Patients presented with both anti-GBM antibodies and M-type phospholipase A2 receptor (anti-PLA2R) antibodies.
- Renal biopsies confirmed PLA2R-associated membranous nephropathy alongside anti-GBM glomerulonephritis.
Main Results:
- All three patients exhibited a combination of membranous nephropathy and anti-GBM glomerulonephritis.
- Despite aggressive treatment, outcomes included progression to chronic kidney disease (CKD) stage 3, need for maintenance hemodialysis, and one fatality due to cerebral infarction.
Conclusions:
- The simultaneous occurrence of membranous nephropathy and anti-GBM disease necessitates a combined diagnostic approach.
- Accurate diagnosis relies on integrating renal biopsy findings with serological testing.
- Early detection is vital for mitigating renal dysfunction and improving patient prognosis.
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