Guo Wilson, O'Donnell Michael
Warren Alpert Medical School of Brown University.
Division of Hospital Medicine, Department of Medicine Brown University Health.
J Brown Hosp Med. 2025 Jul 1;4(3):141754. doi: 10.56305/001c.141754. eCollection 2025.
Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune disorder causing rapidly progressive glomerulonephritis. Early recognition is crucial to prevent irreversible damage. We present a 70-year-old female with hypertension and COPD who had elevated creatinine without respiratory symptoms. Workup revealed elevated anti-GBM antibodies (59 U/mL), anti-MPO antibodies (168 AU/mL), and p-ANCA positivity with kidney biopsy confirming crescentic glomerulonephritis. She was treated with plasmapheresis, corticosteroids, and cyclophosphamide. Her antibody titers declined, and she was discharged on hemodialysis and immunosuppressive therapy. At her 4-week follow-up, renal function had not recovered, and she continued to require hemodialysis. This case highlights the need to consider anti-GBM disease even in isolated renal presentations and emphasizes challenges in managing dual-positive cases. Long-term considerations include maintenance immunosuppression and infection prevention.
抗肾小球基底膜（anti-GBM）病是一种罕见的自身免疫性疾病，可导致快速进展性肾小球肾炎。早期识别对于预防不可逆损伤至关重要。我们报告一例70岁患有高血压和慢性阻塞性肺疾病（COPD）的女性，其肌酐升高但无呼吸道症状。检查发现抗GBM抗体升高（59 U/mL）、抗髓过氧化物酶（MPO）抗体升高（168 AU/mL），且p-ANCA呈阳性，肾活检证实为新月体性肾小球肾炎。她接受了血浆置换、皮质类固醇和环磷酰胺治疗。她的抗体滴度下降，出院时接受血液透析和免疫抑制治疗。在4周的随访中，肾功能未恢复，她仍继续需要血液透析。该病例强调即使在孤立的肾脏表现中也需要考虑抗GBM病，并强调了管理双阳性病例的挑战。长期考虑包括维持免疫抑制和预防感染。
