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A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge

Crescentic glomerulonephritis, also known as rapidly progressive glomerulonephritis, is a syndrome characterized by progressive and rapid deterioration of renal function over the course of weeks to months. Oliguria, hematuria, azotemia, and hypertension are characteristic features of this condition....

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Autores principales: Bell, Stephen, Lattanzio, Natalia, Abdelal, Qassem, Teklie, Yeshanew, Alkayali, Talal, Wiese-Rometsch, Wilhelmine, Sastry, Ashok
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114315/
https://www.ncbi.nlm.nih.gov/pubmed/33966476
http://dx.doi.org/10.1177/23247096211013193
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author Bell, Stephen
Lattanzio, Natalia
Abdelal, Qassem
Teklie, Yeshanew
Alkayali, Talal
Wiese-Rometsch, Wilhelmine
Sastry, Ashok
author_facet Bell, Stephen
Lattanzio, Natalia
Abdelal, Qassem
Teklie, Yeshanew
Alkayali, Talal
Wiese-Rometsch, Wilhelmine
Sastry, Ashok
author_sort Bell, Stephen
collection PubMed
description Crescentic glomerulonephritis, also known as rapidly progressive glomerulonephritis, is a syndrome characterized by progressive and rapid deterioration of renal function over the course of weeks to months. Oliguria, hematuria, azotemia, and hypertension are characteristic features of this condition. Crescentic glomerulonephritis is further classified according to the staining pattern on immunofluorescence. In rare instances, a mixed pattern of injury is encountered as in the case of double antibody-positive rapidly progressive glomerulonephritis (RPGN). This case illustrates the challenge in treatment of double antibody-positive RPGN in an elderly female with no previous renal disease. The patient was found to be positive for anti-GBM antibody and MPO-ANCA. Treatment was initially targeted against MPO-ANCA as the biopsy was most consistent with this process; however, the patient failed to respond to treatment and was subsequently transitioned to oral cyclophosphamide directed against anti-GBM disease. In cases of doubly antibody-positive RPGN with anti-GBM disease and ANCA-associated vasculitis, initial treatment should focus on inducing remission of anti-GBM disease as double antibody-positive disease often presents with the aggressive morbidity and mortality seen in anti-GBM disease, and the chronic risk of relapse seen in ANCA-mediated vasculitis.
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spelling pubmed-81143152021-05-19 A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge Bell, Stephen Lattanzio, Natalia Abdelal, Qassem Teklie, Yeshanew Alkayali, Talal Wiese-Rometsch, Wilhelmine Sastry, Ashok J Investig Med High Impact Case Rep Case Report Crescentic glomerulonephritis, also known as rapidly progressive glomerulonephritis, is a syndrome characterized by progressive and rapid deterioration of renal function over the course of weeks to months. Oliguria, hematuria, azotemia, and hypertension are characteristic features of this condition. Crescentic glomerulonephritis is further classified according to the staining pattern on immunofluorescence. In rare instances, a mixed pattern of injury is encountered as in the case of double antibody-positive rapidly progressive glomerulonephritis (RPGN). This case illustrates the challenge in treatment of double antibody-positive RPGN in an elderly female with no previous renal disease. The patient was found to be positive for anti-GBM antibody and MPO-ANCA. Treatment was initially targeted against MPO-ANCA as the biopsy was most consistent with this process; however, the patient failed to respond to treatment and was subsequently transitioned to oral cyclophosphamide directed against anti-GBM disease. In cases of doubly antibody-positive RPGN with anti-GBM disease and ANCA-associated vasculitis, initial treatment should focus on inducing remission of anti-GBM disease as double antibody-positive disease often presents with the aggressive morbidity and mortality seen in anti-GBM disease, and the chronic risk of relapse seen in ANCA-mediated vasculitis. SAGE Publications 2021-05-08 /pmc/articles/PMC8114315/ /pubmed/33966476 http://dx.doi.org/10.1177/23247096211013193 Text en © 2021 American Federation for Medical Research https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Bell, Stephen
Lattanzio, Natalia
Abdelal, Qassem
Teklie, Yeshanew
Alkayali, Talal
Wiese-Rometsch, Wilhelmine
Sastry, Ashok
A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge
title A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge
title_full A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge
title_fullStr A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge
title_full_unstemmed A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge
title_short A Rare Case of Double Antibody-Positive Rapidly Progressive Glomerulonephritis: A Therapeutic Challenge
title_sort rare case of double antibody-positive rapidly progressive glomerulonephritis: a therapeutic challenge
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114315/
https://www.ncbi.nlm.nih.gov/pubmed/33966476
http://dx.doi.org/10.1177/23247096211013193
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