We report a 49-year-old man with microscopic hematuria, subnephrotic proteinuria, and rapidly progressive renal failure. His biopsy had features of PhosphoLipase A2 Receptor (PLA2R) positive membranous nephropathy with circumferential cellular crescents. Further work-up revealed IgG antiGlomerular Basement Membrane (anti-GBM) antibody titer of 188 U/mL (normal <7 U/mL). A final diagnosis of membranous nephropathy with anti-GBM disease was made. These two distinct pathological entities can occur together resulting in significant morbidity and mortality unless diagnosed early and treatment initiated promptly. Outcomes have been poor, given the nonspecific presentation and delay in diagnosis.
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http://dx.doi.org/10.4103/ijn.IJN_85_19 | DOI Listing |
J Bras Nefrol
January 2025
Universidade Federal de São Paulo (UNIFESP), Departamento de Medicina, Divisão de Nefrologia, São Paulo, SP, Brazil.
Introduction: Glomerular diseases can be associated with solid or hematopoietic malignancies. The prevalence of these associations varies according to the studied glomerular disease. This study aimed to evaluate the frequency and type of neoplasms in patients with glomerular diseases as well as their clinical, laboratory, and histopathological features and the relationship with immunosuppressive therapy.
View Article and Find Full Text PDFIndian J Nephrol
June 2024
Department of Radiology, Pondicherry Institute of Medical Sciences, Kalathumettupathai, Kalapet, Pondicherry, India.
An 80-year-old male with a history of prolonged asbestos exposure presented with 24-hour urine protein of 8 gm, and serum albumin of 1.7 gm/dl. Renal biopsy disclosed features of membranous nephropathy.
View Article and Find Full Text PDFIndian J Nephrol
July 2024
Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
The simultaneous occurrence of vasculitic glomerulonephritis and membranous nephropathy is unusual. We report two cases that presented to our outpatient department with rapidly progressive renal failure. On evaluation, in one patient, anti-myeloperoxidase (MPO) titers were high, and renal biopsy was suggestive of concurrent necrotizing and diffuse crescentic anti-MPO anti-neutrophil cytoplasmic antigen-associated glomerulonephritis with the circumferential cellular crescent formation and membranous glomerulopathy.
View Article and Find Full Text PDFIndian J Nephrol
July 2024
Department of Nephrology, Base Hospital, New Delhi, Delhi Cantt, India.
Obinutuzumab is a glycoengineered type II anti-CD20 monoclonal antibody with superior B cell cytotoxicity compared to rituximab. Various case reports suggest that in refractory phospholipase A2 receptor (PLA2R) positive membranous nephropathy (MN) patients, Obinutuzumab led to immunologic remission and improvement in proteinuria. In the present case series, we present six cases of difficult-to-treat PLA2R-associated MN refractory to prednisolone, calcineurin inhibitor (CNI), cyclophosphamide, and rituximab but subsequently responded to Obinutuzumab.
View Article and Find Full Text PDFIndian J Nephrol
October 2024
Department of Nephrology, Sawai Man Singh Medical College, Jaipur, India.
Membranous nephropathy (MN) is a rare autoimmune disease, in which the circulating autoantibodies against antigens attack podocytes. Neural Epidermal Growth Factor like 1 (NELL1) 1-associated MN is the second most common antigen, following phospholipase A2 receptor. Complementary and alternative medicine and malignancies play a pivotal role in the development of NELL1-MN.
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