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Anti-glomerular basement membrane disease superimposed on membranous nephropathy: a case report and review of the literature

DOI: 10.1186/1752-1947-4-237

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A 59-year-old Hispanic man presented with acute onset of nausea and vomiting and was found to have renal insufficiency. Work-up included a kidney biopsy, which revealed anti-glomerular basement membrane disease with underlying membranous nephropathy. He was treated with emergent hemodialysis, intravenous corticosteroids, plasmapheresis, and cyclophosphamide without improvement in his renal function.Simultaneous anti-glomerular basement membrane disease and membranous nephropathy is very rare. There have been 16 previous case reports in the English language literature that have been associated with a high mortality and morbidity, and a very high rate of renal failure resulting in hemodialysis. Co-existence of membranous nephropathy and anti-glomerular basement membrane disease may be immune-mediated, although the exact mechanism is not clear.Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune disorder with significant morbidity and mortality and is characterized by pulmonary hemorrhage, crescentic glomerulonephritis, and the presence of circulating anti-GBM antibodies which bind to the alpha-3 chain of type 4 collagen found in the glomerular and alveolar basement membranes [1]. The etiology of anti-GBM disease is unclear, but may result from hydrocarbon exposure; specific HLA molecules have also been found to be associated with disease. Anti-GBM disease accounts for approximately 10 to 20 percent of patients with rapidly progressive crescentic glomerulonephritis in the United States. The diagnosis is established by demonstration of high titers of anti-GBM antibodies in the circulation and/or renal biopsy. Early treatment with high-dose corticosteroids, plasmapheresis and cyclophosphamide is recommended because early and appropriate treatment may reverse the extent of renal damage and potentially prevent the need for life-long dialysis. In untreated patients, anti-GBM disease progresses to renal failure and death. There have been very few case re


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