Atypical presentation of anti-GBM nephritis in a 90-year-old patient

Okiro, Julie Omolola; Ebad, Chaudhry Adeel; Khan, Amjad Zaman

doi:10.1136/bcr-2016-217990

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Good pasture syndrome or anti-GBM glomerulonephritis, was first named by Ernest Good Pasture in 1919 (4). A little later, Lerner et al found that anti-GBM antibodies cause this abnormality (5). Anti-GBM nephritis is described as a vasculitis disorder characterised by autoantibody attack against the α3 chain of the type IV non-collagenous domain in the GBM and alveolar basement membrane.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment with intense immunosuppressive therapy in an initially 100% crescentic lesion of anti-GBM nephritis

Phongphithakchai,

Praditau-Krit,

Dandecha

et al. 2021

J Nephropathol

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Anti-glomerular basement membrane (anti-GBM) nephritis is uncommon glomerular disease caused by autoantibodies targeting the capillary beds of the kidney. The clinical presentation of the disease is a variable nephritic syndrome, rapidly progressing to glomerulonephritis. Treatment outcomes are dependent on predictors at first diagnosis. We presented a case of 58-year-old man who did not have underlying disease presented with marked abdominal distension and acute kidney injury. He had no evidence of chronic renal disease before admission however, laboratory test showed microscopic haematuria (RBC 30-50 per high-powered field), proteinuria (2.9 g/d), and renal failure (serum creatinine 610 µmol/L) compatible with rapidly progressive glomerulonephritis; hence, a renal biopsy was conducted. The pathology showed 100% crescentic glomerulonephritis with IgG deposits in a linear pattern at the GBM. The initial serum anti-GBM titre was 105.59 RU/mL. This patient had poor renal prognosis factors for treatment response. After a discussion regarding treatment option with the patient, we decided to give intensive immunosuppressive therapy and plasmapheresis due to his good baseline functional status. The patient achieved partial remission and is not dialysis dependent. In conclusion, despite a poor renal prognosis with 100% crescents and serum creatinine ≥ 600 µmol/L, the treated patient had a good survival status and did not become dialysis-dependent. However, immunosuppressive treatment should be performed along with careful monitoring for infection to avoid infection-related morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Successful treatment with intense immunosuppressive therapy in an initially 100% crescentic lesion of anti-GBM nephritis

Phongphithakchai,

Praditau-Krit,

Dandecha

et al. 2021

J Nephropathol

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“…To our knowledge, our patient, a 91-year-old woman, was the oldest patient at the onset of anti-GBM disease described in the English literature. Prior to our patient, the oldest reported patient in the English literature was a 90-year-old woman [6]. The current recommendation for the treatment of anti-GBM disease is the early introduction of immunosuppressants and plasmapheresis [7].…”

Section: Discussionmentioning

confidence: 99%

A 91-year-old woman with severe aortic stenosis successfully underwent maintenance hemodialysis via arteriovenous fistula after transcatheter aortic valve implantation: a case report with literature review

et al. 2019

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Background: Transcatheter aortic valve implantation (TAVI) has evolved to be a treatment of choice in high-risk patients with aortic stenosis (AS). However, it is not known whether TAVI is safe and beneficial for the creation of arteriovenous fistula for maintenance hemodialysis in high-risk patients with severe AS. Case presentation: A 91-year-old woman was referred to our hospital due to oligoanuria and progressive renal dysfunction. She was diagnosed with anti-glomerular basement membrane (GBM) disease. She had hypertension, chronic kidney disease stage G3b, and AS. We chose not to perform immunosuppressive therapy and plasmapheresis for anti-GBM disease because the risk of death outweighed the benefit of treatment. Hemodialysis with a venous catheter was initiated for the renal indication. As she showed severe AS, she had a risk of cardiac decompensation after arteriovenous fistula creation for dialysis. Following the clinical decision-making process, she underwent TAVI. Although she required the implantation of a cardiac pacemaker for an advanced atrioventricular block that occurred 11 days after TAVI, arteriovenous fistula was successfully created thereafter. She could undergo maintenance hemodialysis using arteriovenous fistula. Conclusions: TAVI is safe and beneficial for the creation of arteriovenous fistula shortly after initiating acute hemodialysis using a catheter in a very old patient with anti-GBM disease.

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Atypical presentation of anti-GBM nephritis in a 90-year-old patient

Cited by 2 publications

References 7 publications

Successful treatment with intense immunosuppressive therapy in an initially 100% crescentic lesion of anti-GBM nephritis

Successful treatment with intense immunosuppressive therapy in an initially 100% crescentic lesion of anti-GBM nephritis

A 91-year-old woman with severe aortic stenosis successfully underwent maintenance hemodialysis via arteriovenous fistula after transcatheter aortic valve implantation: a case report with literature review

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