Bruns F J, Stachura I, Adler S, Segel D P
Arch Intern Med. 1979 Mar;139(3):372-4.
A patient with anti-glomerular basement membrane (GBM)-mediated necrotizing and proliferative glomerulonephritis with crescents was treated with plasmapheresis, cyclophosphamide, and steroids. Treatment resulted in decreased circulating anti-GBM antibody and prompt improvement of renal function that remained stable for 15 months after all treatment was discontinued. Renal biopsies were performed initially, at seven and 17 months. Immunofluorescent examination showed that anti-GBM antibody continued to be present on GBMs although light and electron microscopic findings demonstrated a transformation to a form of sclerosing glomerulonephritis. To our knowledge, this patient's course is the first demonstration that early treatment with plasmapheresis and immunosuppressions may transform the histologic findings in anti-GBM-induced rapidly progressive glomerulonephritis, thereby altering the natural history of this disease.
一名患有抗肾小球基底膜（GBM）介导的伴有新月体形成的坏死性增殖性肾小球肾炎的患者接受了血浆置换、环磷酰胺和类固醇治疗。治疗导致循环抗GBM抗体减少，肾功能迅速改善，在所有治疗停止后肾功能保持稳定达15个月。最初、7个月和17个月时进行了肾活检。免疫荧光检查显示，尽管光镜和电镜检查结果显示已转变为硬化性肾小球肾炎形式，但抗GBM抗体仍存在于肾小球基底膜上。据我们所知，该患者的病程首次证明，早期进行血浆置换和免疫抑制治疗可能会改变抗GBM诱导的急进性肾小球肾炎的组织学表现，从而改变这种疾病的自然病程。
