Anti-glomerular basement membrane nephritis concurrent with lupus nephritis

  • Shimoda Saeko
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Miki Sho
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Taniguchi Keisuke
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Hagihara Kouichirou
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Fumihara Daiki
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Iwanari Sachio
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Ikeda Masaki
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Tanaka Mari
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Takeoka Hiroya
    Department of Nephrology, Hyogo Prefectural Amagasaki General Medical Center
  • Oka Kazumasa
    Department of Pathology, Hyogo Prefectural Nishinomiya Hospital

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Other Title
  • ループス腎炎Ⅴ型の経過中に抗糸球体基底膜抗体腎炎を合併した症例
  • ループスジンエン Ⅴ カタ ノ ケイカ チュウ ニ コウシキュウタイ キテイマク コウタイジンエン オ ガッペイ シタ ショウレイ

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Abstract

A 43-year old male was admitted to our hospital because of nephrotic syndrome and an acute kidney injury. He had a history of lupus nephritis type V 8 years ago, but had achieved complete remission after treatment. Serological tests showed elevated anti-glomerular basement membrane antibody levels. A kidney biopsy examination showed crescentic glomerulonephritis without IgG deposits. Thus, a diagnosis of lupus nephritis type IV+V was made. Steroid therapy was started, and plasma exchange was performed. Despite these therapies, the patient's renal function deteriorated, and hemodialysis was initiated. Intravenous cyclophosphamide pulse therapy was added, but the patient's renal function did not improve. A second kidney biopsy was performed on the 48th day. It showed the linear deposition of IgG along the capillary wall, which led to a diagnosis of anti-glomerular basement membrane disease. A further immunosuppressive regimen was considered to be ineffective. Therefore, the steroid therapy was tapered, and hemodialysis was continued. This case report demonstrates that anti-glomerular basement membrane disease can occur during the course of lupus nephritis.

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