Rapidly progressive renal failure as the primary manifestation of Wegener's granulomatosis

A 43-year-old woman was treated for a rapidly progressive glomerulonephritis with periodic renal dialysis for a period of over one year before the development of a pulmonary lesion which enabled a diagnosis of Wegener's granulomatosis to be made. The lung lesion cleared rapidly with azathioprine and steroid therapy; severe renal failure, however, persisted, necessitating continued hemodialysis. An early and predominant manifestation of a rapidly progressive glomerulonephritis in the presence of minimal, if any, upper respiratory disease, albeit rare, should be considered as a possible presentation of Wegener's granulomatosis.