Frontiers in Medicine (Aug 2015)

Presence of anti-Glomerular basement membrane (GBM) antibodies and Myeloperoxidase anti neutrophilic cytoplasmic antibodies (MPO ANCA) in a case of rapidly progressive glomerulonephritis.

  • Gaurang P Mavani,
  • Max ePommier,
  • Sandar eWin,
  • Michael Frank Michelis,
  • Jordan eRosenstock

DOI
https://doi.org/10.3389/fmed.2015.00053
Journal volume & issue
Vol. 2

Abstract

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A 69 year old male developed rapid deterioration of kidney function and developed uremic symptoms. Creatinine was 486.2 µmol/L (5.5 mg/dl) on presentation. Anti-MPO was positive (titer>8 units, normal <0.4). He was clinically diagnosed with rapidly proliferative glomerulonephritis (RPGN) most likely due to ANCA vasculitis. He received three doses of pulse methylprednisone therapy. Kidney biopsy showed pauci-immune glomerulonephritis. Immunofluoroscence was also positive for faint linear staining of glomerular basement membrane. Anti GBM antibody was positive 2.1U (normal <1). He was started on high dose oral steroids, monthly intravenous cyclophosphamide and plasmapharesis was also initiated. His symptoms improved and creatinine is 247.5 µmol/L (2.8mg/dl). His repeat anti GBM antibody was negative. This is a rare case of rapidly progressive glomerulonephritis due to dual MPO-ANCA antibodies and anti GBM antibodies (DAV).

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