Abstract
Co-presentation of anti GBM and anti MPO antibodies is considered to be a rare phenomena. When patients present both types of antibodies, the condition is referred to as “double positive” for anti-GBM and ANCA associated antibodies which can present clinically as rapidly progressive glomerulonephritis [RPGN], often associated with alveolar bleeding and renal manifestations which constitutes a medical emergency associated with increased morbidity and mortality. In current clinical practice, the diagnosis is obtained through serological tests that detect the presence of antibodies and kidney biopsy to identify their specific histopathological changes. We highlight the role of clinical Biochemistry laboratory and specifically LIA technique in playing a crucial role in identifying the disease thus providing timely intervention to aid better patient outcome.
References
Bell S, Lattanzio N, Abdelal Q, Teklie Y, Alkayali T, Rometsch WW, et al. A rare case of double antibody positive Rapidly Progressive Glomerulonephritis: a therapeutic challenge. J Investig Med High Impact Case Rep. 2021;9:1–5.
Segelmark M, Hellmark T. Anti-glomerular basement membrane disease: an update on subgroups, pathogenesis and therapies. Nephrol Dialysis Transpl. 2019;34(11):1826–32.
Watts RA, Mahr A, Mohammad AJ, Gatenby P, Basu N, Flores-Suarez LF. Classification, epidemiology and subclinical subgrouping of anti-neutrophil cytoplasmic antibody[ANCA]-associated vasculitis. Nephro Dial Transplant. 2015;30:i14–22.
Srivastava A, Rao GK, Segal PE, Shah M, Geetha D. Characteristics and outcome of crescentic glomerulonephritis in patients with both antineutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody. Clin Rheumatol. 2013;32:1317–22. https://doi.org/10.1007/s10067-013-2268-5.
Arimura Y, Muso E, Fujimoto S, Hasegawa M, Kanawe S, Usui J, et al. Evidence-based clinical practice guidelines for rapidly progressive glomerulonephritis. Clin Exp Nephrol. 2016;20:322–41. https://doi.org/10.1007/s10157-015-1218-8.
McAdoo SP, Tanna A, Hruskova Z, Holm L, Weiner M, Arulkumaran N, et al. Patients double seropositive for ANCA and anti GBM antibodies have varied renal survival, frequency of relapse and outcomes compared to single positive patients. Kidney Int. 2017;92:693–702.
Smith C, Dhaliwal G, Saint S, Farkash EA, Garg P. Double trouble. N Engl J Med. 2019;381:1854–60. https://doi.org/10.1056/NEJMcps1810654.
Levy JB, Hammad T, Coulthart A, Doughan T, Pusey CD, et al. Clinical features and outcomes of patients with both ANCA and anti GBM antibodies. Kidney Int. 2004;66:1535–40.
Zhao J, Yang R, Cui Z, Chen M, Zhao MH, Wang HY. Characteristics and outcome of Chinese patients with both antineutrophil cytoplasmic antibody and antiglomerular basement membrane antibodies. Nephron Clin Pract. 2007;107(2):c56–62. https://doi.org/10.1159/000107803.
Cui Z, Zhao J, Jia XY. Anti-glomerular basement membrane disease: outcomes of different therapeutic regimens in a large single-center Chinese cohort study. Medicine [Baltimore]. 2011;90:303–11.
Terakawa K, Niikura T, Katagiri D, Sugita A, Kikuchi T, Hayashi A, et al. A case of rapidly progressive glomerulonephritis with double positive anti-GBM antibody and MPO ANCA after SARS COV-2 vaccination and relapse during 1 year follow up. CEN Case Rep. 2023. https://doi.org/10.1007/s13730-023-00792-9.
Acknowledgements
The authors acknowledge the contributions of the technical staff in the laboratory who processed the samples.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
The case study has been accepted for oral presentation in a national conference scheduled held in Mid September 2023 and conference abstract has been published in IJCB.
Ethical Clearance
It is waived off from our institute for case reports. However, informed consent has been taken from the patient for possible publication in a journal.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mahto, M., Sinha, R.R., Datta, D. et al. Double Jeopardy!. Ind J Clin Biochem (2024). https://doi.org/10.1007/s12291-024-01216-w
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12291-024-01216-w