Concurrent Antiglomerular Basement Membrane Antibody and Immune Complex Mediated Glomerulonephritis

Jennette, J. C.; Lamanna, Roger W.; Burnette, J.P.; Wilkman, A S; Iskander, Sam

doi:10.1016/s0022-5347(17)52277-6

Cited by 5 publications

(6 citation statements)

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“…Immune complex deposition 13 20/M Hematuria "Cytotoxic drugs," PP Recovery Savige 13 18/F Hematuria PP, steroids, CP Chronic kidney disease Elder 14 20/M Hemoptysis, dyspnea, fever, hematuria Steroids, CP Recovery, proteinuria Keilstein 15 17/M Hemoptysis, hematuria Antibiotics Recovery M, male; F, female; CP, cyclophosphamide; PP, plasmapheresis. Adapted from Troxell et al 3 and Patel et al 26 16 19/F Hemoptysis, hematuria Steroids, azathioprine Nephrectomy, dialysis Sharon 17 25/M Hemoptysis, hematuria, edema Steroids, CP, PP Died (pulmonary hemorrhage) Jennette 18 17/M Sore throat, fever, minimal hemoptysis Steroids, CP Recovery Tomaszewski 19 22/F Hemoptysis, hematuria Pettersson 20 20/M Sore throat, fever, lumbar pain, hematuria along the GBM may cause release of damaged GBM antigens into the circulation or unmask cryptic epitopes, which leads to the formation of nephritogenic anti-GBM antibodies. Alternatively, a patient with an initial anti-GBM antibody-mediated renal lesion could have release of GBM antigens into the circulation that then complex with the circulating anti-GBM antibody, leading to glomerular deposition of immune complexes.…”

Section: Discussionmentioning

confidence: 99%

Membranous Nephropathy with Crescents

Basford¹,

Lewis²,

Dwyer³

et al. 2011

Journal of the American Society of Nephrology

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Section: Discussionmentioning

confidence: 99%

Membranous Nephropathy with Crescents

Basford¹,

Lewis²,

Dwyer³

et al. 2011

Journal of the American Society of Nephrology

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“…In a case series, Cui et al [12] estimated the prevalence of immune complex glomerulonephritis and anti-GBM disease in a Chinese cohort to be 28.0%. However, anti-GBM disease with membranoproliferative glomerulonephritis is very rare and there are only 4 reports in the literature that described their clinical picture and possible pathological existence [12][13][14][15]. Existing reports did not identify unique clinical, pathological or laboratory features for anti-GBM disease accompanied by membranoproliferative glomerulonephritis.…”

Section: Discussionmentioning

confidence: 99%

“…However, anti-GBM disease accompanied by membranoproliferative glomerulonephritis is rare and a limited number of case reports have evaluated the possible underlying pathological mechanism and clinical significance [12][13][14][15]. This report describes the unusual clinical presentation of anti-GBM disease with coexistent membranoproliferative glomerulonephritis pattern on renal biopsy.…”

Section: Introductionmentioning

confidence: 99%

Anti-Glomerular Basement Membrane Disease Accompanied by Membrano Proliferative Glomerulonephritis: A Case Report

Hm¹

2017

J Kidney

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Anti-glomerular basement membrane disease is characterized by autoimmunity to antigenic sites on type IV collagen of the glomerular basement membrane. The majority of patients present with rapidly progressive glomerulonephritis and alveolar hemorrhage. The occurrence of anti-glomerular basement membrane disease and other types of glomerulonephritis, such as membranous nephropathy, IgA nephropathy and antineutrophil cytoplasmic antibodies associated vasculitis, is not uncommon. Herein, we describe a patient who presented with worsening kidney function, hemoptysis, and detectable circulating anti-glomerular basement membrane disease antibodies in serum. A kidney biopsy revealed the classical pathological finding of anti-glomerular basement membrane disease, with linear deposition of IgG along the glomerular basement membrane and diffuses extracapillary crescentic sclerosing glomerulonephritis. Likewise, the biopsy revealed a membranoproliferative pattern with abundant C3 deposition. Subsequently, the patient was diagnosed with anti-glomerular basement membrane disease and the rare concurrent existence of membranoproliferative glomerulonephritis. The patient's clinical course was unusual for the anti-glomerular basement membrane disease, with slower progressive decline in renal function and nephrotic range proteinuria. Unfortunately, the presence of membranoproliferative glomerulonephritis did not change the prognosis and the patient lost his renal function irretrievably despite immunosuppressive treatment.

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“…In 7 cases, anti-GBM glomerulonephritis followed MN [4][5][6][7][8][9][10]; in 5 cases, MN followed anti-GBM glomerulonephritis [11][12][13][14]; in 18 cases, anti-GBM glomerulonephritis and MN developed simultaneously (Table 1) [1,5,12,[15][16][17][18][19][20][21][22][23][24][25][26]. A biphasic mechanism has been proposed to explain the pathophysiology of MN following anti-GBM glomerulonephritis and cases of simultaneous disease [1].…”

Section: Discussionmentioning

confidence: 99%

A case of antiglomerular basement membrane glomerulonephritis complicated by membranous nephropathy

et al. 2013

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The sequential or simultaneous presentation of anti-glomerular basement membrane (anti-GBM) glomerulonephritis with membranous nephropathy (MN) has been infrequently reported. Although the mechanism underlying MN superimposed on anti-GBM glomerulonephritis is unknown, the two entities are believed to be interrelated. We report the case of a 75-year-old woman diagnosed with rapidly progressive glomerulonephritis. Renal biopsy revealed crescentic glomerulonephritis with linear and granular staining of immunofluorescent IgG1 and IgG4 granular staining on the capillary loops. Electron microscopy revealed extensive subepithelial deposits. These findings suggested simultaneous development of anti-GBM glomerulonephritis and MN in this case. Serum phospholipase A2 receptor (PLA2R) antibody was negative. The patient was treated with prednisolone and plasma exchange, resulting in resolution of renal insufficiency and a decrease in urinary protein. The rapid decrease in urinary protein and absence of PLA2R antibody suggest that the mechanism of MN associated with anti-GBM glomerulonephritis differs from that of primary MN.

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Concurrent Antiglomerular Basement Membrane Antibody and Immune Complex Mediated Glomerulonephritis

Cited by 5 publications

References 0 publications

Membranous Nephropathy with Crescents

Membranous Nephropathy with Crescents

Anti-Glomerular Basement Membrane Disease Accompanied by Membrano Proliferative Glomerulonephritis: A Case Report

A case of antiglomerular basement membrane glomerulonephritis complicated by membranous nephropathy

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