Pulmonary-renal syndrome in a patient with fibrillary glomerulonephritis

A patient presented with a rapid deterioration in renal function requiring dialysis. Renal biopsy demonstrated fibrillary glomerulonephritis. The patient was treated with steroids and cyclophosphamide and recovered sufficient renal function to discontinue dialysis. However, as immunosuppressive therapy was withdrawn, renal function worsened and the patient developed pulmonary hemorrhage and respiratory distress. Immunosuppressive therapy was reinstituted. During treatment the patient's renal function improved and pulmonary manifestations resolved. This case is further evidence that fibrillary glomerulonephritis can present as a pulmonary-renal syndrome and can respond to aggressive treatment with immunosuppressive agents.