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A case of antiglomerular basement membrane glomerulonephritis complicated by membranous nephropathy

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Abstract

The sequential or simultaneous presentation of anti-glomerular basement membrane (anti-GBM) glomerulonephritis with membranous nephropathy (MN) has been infrequently reported. Although the mechanism underlying MN superimposed on anti-GBM glomerulonephritis is unknown, the two entities are believed to be interrelated. We report the case of a 75-year-old woman diagnosed with rapidly progressive glomerulonephritis. Renal biopsy revealed crescentic glomerulonephritis with linear and granular staining of immunofluorescent IgG1 and IgG4 granular staining on the capillary loops. Electron microscopy revealed extensive subepithelial deposits. These findings suggested simultaneous development of anti-GBM glomerulonephritis and MN in this case. Serum phospholipase A2 receptor (PLA2R) antibody was negative. The patient was treated with prednisolone and plasma exchange, resulting in resolution of renal insufficiency and a decrease in urinary protein. The rapid decrease in urinary protein and absence of PLA2R antibody suggest that the mechanism of MN associated with anti-GBM glomerulonephritis differs from that of primary MN.

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Acknowledgments

The authors are grateful to Dr. Shinichi Akiyama, Dr. Seiichi Matsuo, and Dr. Enyu Imai, Nagoya University, Aichi, Japan, for measurement of PLA2R antibodies in serum.

Conflict of interest

The authors declare that no conflict of interest exists.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Nagaoka Red Cross Hospital, Sensyu-2 297-1, Nagaoka, Niigata, 940-2085, Japan

    Akira Iguchi, Tomomi Ishikawa, Hajime Yamazaki, Tomoyuki Ito & Takako Saeki

  2. Department of Internal Medicine, Ojiya General Hospital, Niigata, Japan

    Yuichi Sakamaki & Yasuo Watanabe

  3. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Yumi Ito, Naohumi Imai & Ichiei Narita

Authors
  1. Akira Iguchi
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  2. Tomomi Ishikawa
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  3. Hajime Yamazaki
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  4. Yuichi Sakamaki
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  5. Tomoyuki Ito
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  6. Yasuo Watanabe
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  7. Takako Saeki
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  8. Yumi Ito
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  9. Naohumi Imai
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  10. Ichiei Narita
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Corresponding author

Correspondence to Akira Iguchi.

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Iguchi, A., Ishikawa, T., Yamazaki, H. et al. A case of antiglomerular basement membrane glomerulonephritis complicated by membranous nephropathy. CEN Case Rep 3, 94–99 (2014). https://doi.org/10.1007/s13730-013-0094-x

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  • DOI: https://doi.org/10.1007/s13730-013-0094-x

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