J Pathol Transl Med.  2019 Nov;53(6):399-402. 10.4132/jptm.2019.08.05.

Concurrent Anti-glomerular Basement Membrane Nephritis and IgA Nephropathy

• Suh KS
• Choi SY
• Bae GE
• Choi DE
• Yeo MK

• KMID: 2465440
• DOI: http://doi.org/10.4132/jptm.2019.08.05

Abstract

Anti-glomerular basement membrane (GBM) nephritis is characterized by circulating anti-GBM antibodies and crescentic glomerulonephritis (GN) with deposition of IgG along the GBM. In a limited number of cases, glomerular immune complexes have been identified in anti-GBM nephritis. A 38-year-old female presented azotemia, hematuria, and proteinuria without any pulmonary symptoms. A renal biopsy showed crescentic GN with linear IgG deposition along the GBM and mesangial IgA deposition. The patient was diagnosed as concurrent anti-GBM nephritis and IgA nephropathy. Therapies with pulse methylprednisolone and cyclophosphamide administration were effective. Concurrent cases of both anti-GBM nephritis and IgA nephropathy are rare among cases of anti-GBM diseases with deposition of immune complexes. This rare case of concurrent anti-GBM nephritis and IgA nephropathy with literature review is noteworthy.

Keyword

Anti-glomerular basement membrane disease; Immunoglobulin A; Crescentic glomerulonephritis

MeSH Terms

Adult
Anti-Glomerular Basement Membrane Disease
Antibodies
Antigen-Antibody Complex
Azotemia
Basement Membrane*
Biopsy
Cyclophosphamide
Female
Glomerulonephritis
Glomerulonephritis, IGA*
Hematuria
Humans
Immunoglobulin A*
Immunoglobulin G
Methylprednisolone
Nephritis*
Proteinuria
Antibodies
Antigen-Antibody Complex
Cyclophosphamide
Immunoglobulin A
Immunoglobulin G
Methylprednisolone

Figure

• 

  Fig. 1. (A) Light microscopy shows encircling cellular crescents (periodic acid–Schiff staining). Imunofluorescence shows linear deposition of IgG along the glomerular basement membrane (GBM) (B) and granular deposition of IgA in mesangial spaces (C). (D) Electron microscopy shows a diffusely wrinkled GBM and mesangial electron-dense deposition (arrow) (uranyl acetate/lead citrate staining, ×8,000).

• 

  Fig. 2. Clinical course of the patient. GBM, glomerular basement membrane; PD, prednisolone.

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