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Tan SJ, Ducharlet K, Dwyer KM, et al. A case of triple pathology: seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis and membranous nephropathy in a patient with underlying diabetic kidney disease. Clin Kidney J. 2013;6(3):322-6doi: 10.1093/ckj/sft043.
Tan, S. J., Ducharlet, K., Dwyer, K. M., Myers, D., Langham, R. G., & Hill, P. A. (2013). A case of triple pathology: seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis and membranous nephropathy in a patient with underlying diabetic kidney disease. Clinical kidney journal, 6(3), 322-6. https://doi.org/10.1093/ckj/sft043
Tan, Sven-Jean, et al. "A case of triple pathology: seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis and membranous nephropathy in a patient with underlying diabetic kidney disease." Clinical kidney journal vol. 6,3 (2013): 322-6. doi: https://doi.org/10.1093/ckj/sft043
Tan SJ, Ducharlet K, Dwyer KM, Myers D, Langham RG, Hill PA. A case of triple pathology: seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis and membranous nephropathy in a patient with underlying diabetic kidney disease. Clin Kidney J. 2013 Jun;6(3):322-6. doi: 10.1093/ckj/sft043. PMID: 26064494; PMCID: PMC4400487.
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Clin Kidney J. 2013 Jun;6(3):322-6. doi: 10.1093/ckj/sft043.

A case of triple pathology: seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis and membranous nephropathy in a patient with underlying diabetic kidney disease.

Clinical kidney journal

Sven-Jean Tan, Kathryn Ducharlet, Karen M Dwyer, Damian Myers, Robyn G Langham, Prue A Hill

Affiliations

  1. Department of Nephrology , St Vincent's Hospital , Fitzroy, VIC , Australia.
  2. Department of Surgery and Orthopaedics , St Vincent's Hospital , Fitzroy, VIC , Australia.
  3. Department of Nephrology , St Vincent's Hospital , Fitzroy, VIC , Australia ; Department of Medicine , University of Melbourne , Parkville, VIC , Australia.
  4. Department of Anatomical Pathology , St Vincent's Hospital , Fitzroy, VIC , Australia.

PMID: 26064494 PMCID: PMC4400487 DOI: 10.1093/ckj/sft043

Abstract

In diabetic patients with acute kidney injury (AKI), kidney biopsy often reveals non-diabetic kidney pathology. This case describes a patient with known Type 1 diabetes who presented with AKI, nephrotic syndrome and haematuria. Combination pathology of seronegative anti-glomerular basement membrane antibody-mediated glomerulonephritis (anti-GBM GN), membranous nephropathy (MN) and diabetic nephropathy (DN) was demonstrated. Strong linear GBM IgG-staining on biopsy with crescentic GN and clinical AKI led to a diagnosis of anti-GBM GN, although serum antibodies were not detectable. Features of DN, Kimmelstiel-Wilson nodules and albumin staining were also present, along with features of MN, such as subepithelial deposits on electron microscopy. Despite treatment with immunosuppression and plasmapheresis, there was no recovery of kidney function. Coexisting anti-GBM GN and MN is well recognized, but the concurrent diagnosis with DN has not been described.

Keywords: anti-glomerular basement membrane (GBM) disease; diabetic nephropathy; membranous nephropathy; seronegative disease

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