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BMJ Case Reports 2017; doi:10.1136/bcr-2017-222080
  • Rare disease
  • CASE REPORT

ANCA and IgA glomerulonephritis all in one: prognosis and complications

  1. Belinda Jim1
  1. 1Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, NY, USA
  2. 2Department of Pathology, Columbia University Medical Center, New York, USA
  1. Correspondence to Dr Belinda Jim, belindajim286{at}gmail.com
  • Accepted 25 September 2017
  • Published 9 October 2017

Summary

We present the case of a 75-year-old Hispanic woman with known stage 3 chronic kidney disease, long-standing hypertension and type 2 diabetes mellitus who presented with right-sided abdominal pain and acute kidney injury, nephrotic range proteinuria with positive antimyeloperoxidase antibody. A renal biopsy revealed IgA nephropathy with superimposed pauci-immune antineutrophilic cytoplasmic antibody (ANCA)-associated crescentic glomerulonephritis. The patient was treated with pulse intravenous methylprednisolone, cyclophosphamide and plasmapheresis. One week after her second dose of cyclophosphamide, she was readmitted for infectious complications including influenza A respiratory infection, Rothia bacteraemia associated with diarrhoea and herpes zoster of the trunk. In this report, we review the prevalence, treatment and prognosis of coexistent IgA nephropathy and pauci-immune ANCA-associated crescentic glomerulonephritis. We propose that a reduced-dose treatment regimen should be considered in elderly patients due to their higher risk of infectious complications. Current literature suggests that this treatment approach may reduce infectious complications without compromising therapeutic efficacy.

Footnotes

  • Contributors PN researched and prepared the manuscript. VD’A contributed to the pathology assessment and writing of the manuscript. KA took care of the patient and helped to design the manuscript. BJ took care of the patient and helped to design and write the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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