Case of anti-glomerular basement membrane antibody nephritis in a patient who was able to withdraw from dialysis and gave birth twice but underwent living renal transplantation due to progression to end-stage renal failure 15 years after onset

A 34-year-old woman with suspected rapidly progressive glomerulonephritis had been admitted to our hospital in March 1993 at the age of 19 years. Renal biopsy revealed cellular crescent formation in 24 of 26 glomeruli. Serum examination was positive for anti-glomerular basement membrane (GBM) antibo...

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Published inNihon Jinzo Gakkai shi Vol. 51; no. 8; p. 1080
Main Authors Iwamoto, Ichiro, Naiki, Yoshito, Nose, Kazuhiro, Akiyama, Takahiro, Sakaguchi, Mika, Matsuoka, Toshiaki, Samejima, Kenichi, Hiroaki, Sato, Funauchi, Masanori
Format Journal Article
LanguageJapanese
Published Japan 2009
Subjects
Adult
Autoantibodies
Disease Progression
Female
Glomerular Basement Membrane - immunology
Humans
Kidney Failure, Chronic - etiology
Kidney Failure, Chronic - therapy
Kidney Transplantation
Methylprednisolone - administration & dosage
Nephritis - complications
Nephritis - therapy
Plasma Exchange
Pregnancy
Pregnancy Complications
Pregnancy Outcome
Pulse Therapy, Drug
Renal Dialysis
Time Factors
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Summary:A 34-year-old woman with suspected rapidly progressive glomerulonephritis had been admitted to our hospital in March 1993 at the age of 19 years. Renal biopsy revealed cellular crescent formation in 24 of 26 glomeruli. Serum examination was positive for anti-glomerular basement membrane (GBM) antibody, while pulmonary hemorrhage was absent. Based on these findings, she was diagnosed with anti-GBM antibody nephritis, and treated with corticosteroid pulse therapy and double filtration plasmapheresis (DFPP) in addition to hemodialysis (HD). HD was withdrawn within 2 months. Wishing to have a baby, she had delivery in 1997 and 2000. Subsequently, her renal function gradually decreased, and she underwent an ABO-incompatible living-donor kidney transplant, with her husband as the donor, in March 2008. She has been making good progress after transplantation. Anti-GBM antibody nephritis has a poor prognosis, but renal function was maintained for 15 years in this patient, who responded well to the initial treatment. The underlying disease rarely recurs if transplantation is performed after the patient has become negative for anti-GBM antibody, anti-GBM antibody nephritis therefore seems to be a good indication for treating patients with renal transplantation.
ISSN:0385-2385