Abstract: PUB211
From Missed Diagnosis to Dialysis: Unraveling the Journey of Severe Anti-GBM Glomerulonephritis, a Case Report
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Hirani, Chetna N, Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Bethea, Meaghan, Ross Medical Education Center - Ann Arbor, Ann Arbor, Michigan, United States
- Giddings, Sara, Ross Medical Education Center - Ann Arbor, Ann Arbor, Michigan, United States
- Shastri, Kinjel, Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Bhatt, Parjanya K., Trinity Health Oakland Hospital, Pontiac, Michigan, United States
Introduction
Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune condition that can lead to rapidly progressive glomerulonephritis and irreversible kidney damage. Prompt recognition and treatment are essential for preserving renal function. We report a case of a patient with anti-GBM disease who experienced a delayed diagnosis and subsequently progressed to needing dialysis, despite receiving appropriate therapy.
Case Description
A 68-year-old woman with a history of autoimmune and oncologic conditions presented with fatigue and microscopic hematuria. Initially, autoimmune testing was delayed, and she was treated empirically for a presumed urinary tract infection. Over the course of six weeks, her renal function deteriorated, leading to a diagnosis of acute kidney injury. A kidney biopsy, performed more than a month after the onset of her symptoms, revealed diffuse crescentic and necrotizing glomerulonephritis with linear IgG staining, which was consistent with anti-GBM disease. She was subsequently transferred to our center, where she was anuric and required urgent plasmapheresis, intravenous cyclophosphamide, and high-dose steroids. Despite a significant reduction in anti-GBM titers, her renal function did not improve, and she remained dependent on dialysis. She was discharged on immunosuppressive therapy and supportive care, with outpatient hemodialysis scheduled.
Discussion
This case highlights the critical importance of conducting an early autoimmune workup in patients who present with persistent hematuria and systemic symptoms. Although anti-GBM disease is rare, it often leads to irreversible damage if not diagnosed and treated promptly. Despite receiving aggressive therapy, late intervention in our patient did not restore renal function. Clinicians should maintain a high level of suspicion in similar cases, particularly in patients with a history of autoimmune disorders. Timely diagnosis through serological tests and biopsy is essential to initiate treatments that can save both lives and kidney function, thereby preventing the need for dialysis.