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Abstract: SA-PO725

A Case of Concomitant Anti-Glomerular Basement Membrane (Anti-GBM) Disease and Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Ogbolu, Cora O., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Maldonado, Dawn, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Ediale, Temi-Ete I., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Guadalupe, Joseph, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Ward, Stephen C., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Bhatti, Saad A., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Stern, Aaron S., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Brown, Maritza, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Introduction

There have been few cases of anti-glomerular basement membrane disease co-existing with membranous nephropathy (MN). We present a case of this rare dual pathology.

Case Description

A 56-year-old man with hypertension presented to the emergency room with dark urine and oliguria. He denied fever, dyspnea or hemoptysis. He had stable vitals, clear lungs, leg edema, and no rashes. Creatinine was 9.5 mg/dL (0.9 8 months ago).
Urine microscopy showed red blood cell casts. Anti-GBM was 194 U. ANA, ANCA, complements, and anti-PLA2r were normal. Kidney biopsy revealed cellular crescents, and immunofluorescence showed linear IgG and C3 (figure 1). Electron microscopy showed subepithelial and rare intramembranous immune deposits (figure 2). The final diagnosis was anti-GBM and MN.
The patient was treated with pulse steroids, cyclophosphamide, and plasma exchange alternating with dialysis. Despite 2 weeks of plasma exchange, anti-GBM remained elevated at 46 U. He remains dialysis-dependent after 3 months.

Discussion

Only a few case reports have described the co-existence of anti-GBM and MN. Renal outcomes are worse than in patients with either diagnosis alone, which was the case for our patient. The fact that anti-GBM titers remained elevated despite plasmapheresis suggests that a systemic factor led to its active production. This factor may be related to the MN. This case highlights the need for elucidation of a target antigen that may trigger both diseases.