Alhozali HM
Anti-glomerular basement membrane disease is characterized by autoimmunity to antigenic sites on type IV collagen of the glomerular basement membrane. The majority of patients present with rapidly progressive glomerulonephritis and alveolar hemorrhage. The occurrence of anti- glomerular basement membrane disease and other types of glomerulonephritis, such as membranous nephropathy, IgA nephropathy and antineutrophil cytoplasmic antibodies associated vasculitis, is not uncommon. Herein, we describe a patient who presented with worsening kidney function, hemoptysis, and detectable circulating anti-glomerular basement membrane disease antibodies in serum. A kidney biopsy revealed the classical pathological finding of anti-glomerular basement membrane disease, with linear deposition of IgG along the glomerular basement membrane and diffuses extracapillary crescentic sclerosing glomerulonephritis. Likewise, the biopsy revealed a membranoproliferative pattern with abundant C3 deposition. Subsequently, the patient was diagnosed with anti-glomerular basement membrane disease and the rare concurrent existence of membranoproliferative glomerulonephritis. The patient’s clinical course was unusual for the anti-glomerular basement membrane disease, with slower progressive decline in renal function and nephrotic range proteinuria. Unfortunately, the presence of membranoproliferative glomerulonephritis did not change the prognosis and the patient lost his renal function irretrievably despite immunosuppressive treatment.