A 66-year-old Asian woman presented with severe kidney injury, microscopic haematuria and subnephrotic range proteinuria with elevated serum anti-glomerular basement membrane (anti-GBM) titre. She had a history of renal cell carcinoma. Renal biopsy revealed dual pathology with immunofluorescence showing 3+ linear glomerular IgG staining and 3+ IgA mesangial staining. Cellular crescents were present on light microscopy and electron microscopy revealed increased mesangial matrix. She was treated with plasma exchange and immunosuppression and remained in stage 4 chronic kidney disease. This case describes the coexistence of anti-GBM disease and IgA nephropathy, a phenomenon not well described in the literature. The report also explores the association of malignancy and glomerulonephritis as well as the role of genetics and the utility of human leukocyte antigen (HLA) typing in risk stratification.
- acute renal failure
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Contributors CK conceived the idea of the case report, collected patient’s clinical information, analysed and interpreted investigation results, performed literature review, drafted and edited the case report and discussion, approved final version of the report, agreed to be accountable for all aspects of the work. MGW collected patient’s clinical information, analysed and interpreted investigation results, edited and critically revised case report and discussion and approved final version of the report, agreed to be accountable for all aspects of the work. JR provided the light microscopy and immunofluorescence renal biopsy images, provided the legend for the histopathology figure, edited and critically revised case report and discussion, approved final version of the report, agreed to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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