Ibrahim D, Brodsky SV, Satoskar AA, Biederman L, Maroz N. Triple hit to the kidney-dual pathological crescentic glomerulonephritis and diffuse proliferative immune complex-mediated glomerulonephritis: A case report. World J Clin Cases 2022; 10(32): 11869-11876 [PMID: 36405258 DOI: 10.12998/wjcc.v10.i32.11869]
Corresponding Author of This Article
Sergey V Brodsky, MD, PhD, Academic Research, Department of Pathology, Ohio State University, 333 w 10th Ave Graves Hall B078, Columbus, OH 43210, United States. sergey.brodsky@osumc.edu
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 16, 2022; 10(32): 11869-11876 Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11869
Triple hit to the kidney-dual pathological crescentic glomerulonephritis and diffuse proliferative immune complex-mediated glomerulonephritis: A case report
Dalia Ibrahim, Sergey V Brodsky, Anjali A Satoskar, Laura Biederman, Natallia Maroz
Dalia Ibrahim, Sergey V Brodsky, Anjali A Satoskar, Laura Biederman, Department of Pathology, Ohio State University, Columbus, OH 43210, United States
Natallia Maroz, Department of Medicine, Wright State University, Dayton, OH 45409, United States
Author contributions: Ibrahim D wrote a draft of the manuscript and acquired the images; Brodsky SV interpreted the case, reviewed critically drafts and approved the final version; Maroz N wrote the clinical information and treatment parts, contributed to the discussion, and revised the manuscript critically and approved the final version; Satoskar AA and Biederman L reviewed drafts and gave their pathology input and modifications and approved the final version.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sergey V Brodsky, MD, PhD, Academic Research, Department of Pathology, Ohio State University, 333 w 10th Ave Graves Hall B078, Columbus, OH 43210, United States. sergey.brodsky@osumc.edu
Received: May 16, 2022 Peer-review started: May 16, 2022 First decision: June 27, 2022 Revised: July 25, 2022 Accepted: August 21, 2022 Article in press: August 21, 2022 Published online: November 16, 2022 Processing time: 175 Days and 10.2 Hours
Abstract
BACKGROUND
Anti-glomerular basement membrane (GBM) disease is a rare rapidly progressive glomerulonephritis, frequently associated with alveolar hemorrhage in the lungs and involving the kidney by crescentic glomerulonephritis. It has been described in association with other glomerulonephritides [such as anti-neutrophilic antibody (ANCA)-glomerulonephritis, membranous nephropathy, and immunoglobulin (Ig)A nephropathy].
CASE SUMMARY
Herein we present an unusual case of concurrent anti-GBM disease, ANCA-associated crescentic glomerulonephritis and diffuse proliferative immune complex mediated glomerulonephritis with predominant staining for IgA and C3 by immunofluorescence. The patient is a 46-year-old Caucasian male who presented to the emergency department with acute onset of flank pain and was found to have high serum creatinine levels of 15 mg/dL, proteinuria, and hematuria. He rapidly deteriorated and became anuric. He was found to have high anti-GBM antibodies titers (151 units) and high anti-neutrophil cytoplasmic-ANCA. Despite prompt and early treatment, the patient’s condition worsened, and he succumbed to his illness.
CONCLUSION
Our case emphasizes the importance of a renal biopsy in anti-GBM disease, even in the presence of positive serum anti-GBM antibodies, to identify other potential causes of rapidly progressive glomerulonephritis. The challenge in treating such cases lies in the different therapy modalities.
Core Tip: Unusual constellation of morphologic findings in the kidney, that include anti-glomerular basement membrane disease, anti-neutrophilic antibody-associated crescentic and necrotizing glomerulonephritis and immune-complex mediated glomerulonephritis with unusual pathogenesis and grave outcome for the patient. Kidney biopsy is warranted in patients with rapidly progressive decline in kidney function and hematuria to reveal the diagnosis, pathogenesis and the optimal treatment course.
