Guo Chuan, Ye Ming, Li Shen, Zhu Ting-Ting, Rao Xiang-Rong
Department of Nephrology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
World J Clin Cases. 2022 Apr 26;10(12):3916-3922. doi: 10.12998/wjcc.v10.i12.3916.
Anti-glomerular basement membrane (GBM) disease is a rare autoimmune disease manifesting as acute progressive nephritis syndrome with or without varying degrees of pulmonary hemorrhage. Anti-GBM disease coexisting with Immunoglobulin A (IgA) nephropathy is rarer and has different clinical manifestations and prognoses than simple anti-GBM disease. We describe a case of coexistence of these two diseases.
A 49-year-old man with hematuria and proteinuria accompanied by a slight elevation of serum creatinine was admitted to our hospital. The pathological results of renal biopsy and the elevated serum anti-GBM antibody titer supported a diagnosis of anti-GBM disease combined with IgA nephropathy. After treatment with corticosteroids and cyclophosphamide, the patient's serum creatinine was relatively stable, and the hematuria and proteinuria moderately improved in the subsequent six months.
Anti-GBM disease coexisting with IgA nephropathy is rare. The clinical manifestations and prognosis are better than those of simple anti-GBM disease. In this case, the patient's condition was improved and his renal function remained relatively stable with corticosteroid and cyclophosphamide treatment. New detection methods to identify whether the crescents in this case were derived from anti-GBM disease or IgA nephropathy are worthy of further exploration.
抗肾小球基底膜（GBM）病是一种罕见的自身免疫性疾病，表现为急性进行性肾炎综合征，伴有或不伴有不同程度的肺出血。抗GBM病与免疫球蛋白A（IgA）肾病共存更为罕见，其临床表现和预后与单纯抗GBM病不同。我们报告一例这两种疾病共存的病例。
一名49岁男性因血尿、蛋白尿伴血清肌酐轻度升高入院。肾活检病理结果及血清抗GBM抗体滴度升高支持抗GBM病合并IgA肾病的诊断。经糖皮质激素和环磷酰胺治疗后，患者血清肌酐相对稳定，血尿和蛋白尿在随后6个月中有所改善。
抗GBM病与IgA肾病共存罕见。其临床表现和预后优于单纯抗GBM病。本例患者经糖皮质激素和环磷酰胺治疗后病情改善，肾功能保持相对稳定。鉴别本例中新月体是源自抗GBM病还是IgA肾病的新检测方法值得进一步探索。
