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Kidney Week

Abstract: PO1518

Crescentic Glomerulonephritis and Membranous Nephropathy: A Case Report of a Rare Overlap

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Ghandour, Mohamedanwar M., Wayne State University, Detroit, Michigan, United States
  • Bhat, Zeenat Yousuf, Wayne State University, Detroit, Michigan, United States
Introduction

Membranous nephropathy (MN) is a disease that affects the basement membrane of the glomeruli of the kidney resulting in proteinuria. The concurrent incidence of vasculitic glomerulonephritis and MN in the same patient is unusual. Herein, we report a case with this unusual combination.

Case Description

Our patient is a 53-year-old Hispanic male with a past medical history of tobacco use, type 2 diabetes mellitus, and hypertension who presented with hematuria and was found to have nephrotic range proteinuria and renal impairment. Blood workup revealed positive ANCA serology, which led to a renal biopsy that showed crescentic vasculitis in addition to membranous nephropathy. The patient was started on intermittent hemodialysis (HD) and treated initially with intravenous (IV) pulse steroids; subsequently, oral prednisolone and IV cyclophosphamide was initiated. The patient remained HD dependent at the time of discharge with the resolution of hematuria. A follow-up with an outpatient nephrology clinic was arranged.

Discussion

Membranous nephropathy complicated by crescentic glomerulonephritis has a more aggressive clinical course and decline in renal function compared to MN alone which can lead to initiating renal replacement therapy. However, immunosuppressive drugs can result in significant improvement of renal function if started early enough.

Light microscopy shows diffuse cellular crescent formation

Light microscopy shows a glomerulus with focal segmental fibrinoid necrosis