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Abstract: FR-PO611

Gross Hematuria: Initial Atypical Manifestation of Anti-Glomerular Basement Membrane Disease

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Gomez Villarreal, Juan Pablo, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
  • López Villa, Nayeli Nicté, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
  • Aguilar, Rita Belinda, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
  • Guerrero Gonzalez, Elisa Maria, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
  • Rizo Topete, Lilia Maria, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
  • Arteaga Muller, Giovanna Y., Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
Introduction

Anti-glomerular basement membrane disease or Goodpasteur syndrome is a rare disease that affects < 2/1,000,000 people annually. Goodpasteur syndrome is a small vessel vasculitis that targets the a3 chain of the type 4 collagen of the glomerular and alveolar membranes. Anti-GMB disease has a high morbidity whit almost all patient leading to kidney failure. Our case presents a atypical symptom of Anti-GMB disease.

Case Description

A 31-year-old man whit history of Hodgkin lymphoma in 2011 was admitted to the ER for hematuria, during his evaluation he mentions that has been with this symptom for one month without pain or tenesmus, he refers that 3 days ago start whit hemoptoic coughing, during his assessment his blood pressure was 170/90 mmHg and the only relevant on the physical exploration was decreased breath sounds at lung bases. Admission: Hgb 10.50 g/dL WBC 11.10 K/uL Plt 221 K/uL SCr 11.3mg/dL, BUN 62mg/dL, Urinalysis had 612 mg/dL of proteinuria, hematuria 200 hem/uL, erytrocyturia > 100/ field, serologic anti-GMB 105.37 UR/mL. was positive. Treatment started with metilprednisolone for 3 days then switched to prednisone, cyclophosphamide and plasma exchange with albumin started. Hemodialysis started as support therapy and renal biopsy was performed.

Discussion

Anti-GMB disease is known for his aggressive course treatment is very hard to achieve in low income country’s due de lack of equipment for plasma exchange, our patient was treated as mention above but the engaging part of the case is that we executed plasma exchange treatment using albumin without the frozen plasma at the end because the unavailability in our center; the literature mentions that patients with alveolar hemorrhage should use frozen plasma during de plasma exchange or if you use albumin give frozen plasma at the end of the exchange, even though we did the plasma exchange with albumin the patient had a good clinical response.