Subject(s)
Kidney Diseases , Kidney , Biopsy , Humans , Kidney Diseases/diagnosis , Kidney Diseases/therapySubject(s)
Hydrothorax/therapy , Peritoneal Dialysis/adverse effects , Aged , Humans , Hydrothorax/etiology , MaleSubject(s)
Image-Guided Biopsy/adverse effects , Kidney Diseases/pathology , Kidney/pathology , Ultrasonography, Interventional/adverse effects , Humans , Image-Guided Biopsy/instrumentation , Image-Guided Biopsy/methods , Needles , Patient Safety , Predictive Value of Tests , Risk Assessment , Risk FactorsSubject(s)
Glomerulonephritis/etiology , Legionellosis/complications , Adult , Female , Humans , Kidney Glomerulus/physiopathologySubject(s)
Humans , Female , Adult , Legionellosis/complications , Glomerulonephritis/etiology , Kidney Glomerulus/physiopathologySubject(s)
Acute Kidney Injury/diagnosis , Kidney/pathology , Nephritis, Interstitial/diagnosis , Acute Kidney Injury/etiology , Acute Kidney Injury/pathology , Acute Kidney Injury/therapy , Adrenal Cortex Hormones/therapeutic use , Aged , Biopsy , Humans , Male , Nephritis, Interstitial/etiology , Nephritis, Interstitial/pathology , Nephritis, Interstitial/therapy , Predictive Value of Tests , Renal Dialysis , Risk Factors , Time Factors , Treatment OutcomeSubject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy , Glomerulonephritis/therapy , Granulomatosis with Polyangiitis/therapy , Hemolytic-Uremic Syndrome/therapy , Plasmapheresis , Female , Glomerulonephritis/etiology , Humans , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/therapy , Male , Plasmapheresis/adverse effects , Plasmapheresis/methods , Steroids/therapeutic useABSTRACT
Acute crescentic transformation is a rare but well described event in patients with membranous glomerulonephritis. We report our experience with a 66-year-old Caucasian man presented for rapid decline in renal function. For nearly 10 years, he was suffering from hypertension and mixed sensori-motor polyneuropathy. He performed therapy with prednisone and azathioprine, suspended 1 year before presentation. Moreover, six months before presentation, laboratory tests showed a serum creatinine concentration 220 mol/L and a 24-h protein excretion 0,75 g/d. The physical examination showed oedema and severe hypertension; the 24-h protein excretion was 1,1 gr/d and creatinine concentration was 550.8 mol/L; ANCA and other immunological tests were negative. There was no evidence of SLE, infection or malignancy. The kidney biopsy highlighted a membranous GN with crescentic overlap. The patient was treated with steroid and cyclophosphamide. Because there was no sign of improvement after 2 months, we stopped the cyclophosphamide therapy and the patient started chronic haemodialysis treatment. Unlike membranous nephropathy, patients with superimposed crescentic glomerulonephritis appear to have a more aggressive clinical course. The importance of recognizing this group of patients with membranous nephropathy and crescentic glomerulonephritis is that immunosuppressive therapy may ameliorate the progression of renal damage and in some cases early treatment was associated with useful recovery of renal function.
Subject(s)
Glomerulonephritis, Membranoproliferative/complications , Glomerulonephritis, Membranous/complications , Aged , Glomerulonephritis, Membranoproliferative/pathology , Glomerulonephritis, Membranous/pathology , Humans , MaleABSTRACT
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