Double positive Anti-GBM and ANCA-associated glomerulonephritis – A case report

Abstract

Double-Positive Anti-Glomerular Basement Membrane (Anti-GBM) and Anti-Neutrophil Cytoplasm Antibody (ANCA)- Associated Glomerulonephritis is a rare disease. The disease is characterized by concurrent presence of Anti-GBM antibodies and ANCA in a patient. The patient usually presents with rapidly progressive glomerulonephritis with or without pulmonary haemorrhage. We report a case of a middle-aged gentleman who presented acute kidney injury with a serum creatinine level of 459umol/L. He was tested positive for both Anti-GBM and ANCA with high titers. He underwent 6 cycles of plasma exchange, pulse IV cyclophosphamide and high dose steroid. During his 6 months outpatient review, a total of 6 doses IV cyclophosphamide has been given and his serum creatinine reduced to 146 umol/L. In conclusion, the use of pulse IV cyclophosphamide over oral form in this subject is empirical and showed marked improvement of renal function.