Anti-glomerular basement membrane disease associated with thin basement membrane nephropathy: A case report.
Medicine (Baltimore)
; 100(20): e26095, 2021 May 21.
Article
em En
| MEDLINE
| ID: mdl-34011133
ABSTRACT
RATIONALE Simultaneous occurrence of anti-glomerular basement membrane (anti-GBM) disease and thin basement membrane nephropathy (TBMN), both of which invade the type IV collagen subunits, is very rare. Here, we present the case of a 20-year-old male patient diagnosed with both anti-GBM disease and TBMN upon presenting dyspnea and hemoptysis. PATIENT CONCERNS No laboratory abnormalities, except arterial hypoxemia (PaO275.4âmmHg) and microscopic hematuria, were present. Chest computed tomography revealed bilateral infiltrations in the lower lung fields; thus, administration of empirical antibiotics was initiated. Gross hemoptysis persisted nonetheless, and bronchoscopy revealed diffuse pulmonary hemorrhage with no endobronchial lesions. Broncho-alveolar lavage excluded bacterial pneumonia, tuberculosis, and fungal infection. DIAGNOSIS Enzyme-linked immunosorbent assay of his serum was positive for anti-GBM antibody (95.1âU/mL). Human leukocyte antigen (HLA) test was positive for both HLA-DR15/-DR04. Other than diffuse thinning of the GBM (average thickness, 220ânm), index kidney biopsy did not demonstrate any specific abnormalities such as crescent formation. INTERVENTIONS:
Methylprednisolone was administered intravenously for 7 consecutive days (500âmg/day), followed by the daily dose of oral prednisolone (80âmg). Cyclophosphamide was also orally administered every day for 3 months (250âmg/day). Following 6 sessions of plasmapheresis, the anti-GBM antibody in serum became negative.OUTCOMES:
There was no clinical evidence suggesting recurrence of pulmonary hemorrhage or azotemia during hospitalization and 12-month follow-up period. Twelve months after hospital discharge, oral prednisolone was discontinued. LESSONS The patients with concurrent anti-GBM disease and TBMN will have a favorable prognosis after proper therapy. However, further research is needed to elucidate the pathogenesis and long-term outcome of the comorbidity of these 2 diseases.
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
Base de dados:
MEDLINE
Assunto principal:
Doença Antimembrana Basal Glomerular
/
Nefropatias
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
/
Male
Idioma:
En
Revista:
Medicine (Baltimore)
Ano de publicação:
2021
Tipo de documento:
Article