A rare complication of idiopathic membranous nephropathy: crescentic transformation.

摘要

INTRODUCTION: In this study, the cause of rapidly deteriorating renal functions in a follow-up period of a 65-year-old female patient, who applied with nephrotic syndrome findings and diagnosed as membranous nephropathy, is presented. CASE REPORT: A 65-year-old patient with findings of nephrotic syndrome had normal kidney size and serum complement level, and was negative for autoantibodies and viral serology. In histopathologic examination, 20 glomeruli were consistent with membranous glomerulonephritis. The patient, evaluated for idiopathic membranous nephropathy, was followed-up monthly with supportive treatment. In the second month of follow-up, a re-evaluation of the patient due to nausea and urine discoloration revealed 144 mg/dL urea, 6.3 mg/dL creatinine, and 2.5 g/dL albumin. Urine sediment revealed dysmorphic erythrocytes and granular silenders. Renal re-biopsy was done. Of 11 glomeruli, three global sclerosis and eight crescentic glomeruli with fibrosis and scarce cellular component were seen. The case was accepted as crescentic glomerulonephritis, a rare complication of idiopathic MN. Before the treatment, antiGBM, pANCA, cANCA, and ANA were negative. Pulse metil prednisolone and pulse cyclophosphamide treatment protocol was administered. Hemodialysis was needed nine times. At the end of first month of the treatment, hemodialysis was no longer needed. CONCLUSION: Due to a risk of spontaneous remission up to 30% of membranous nephropathy, there is no consensus on specific treatment applicable to all cases. However, crescentic GN should be investigated immediately when sudden and rapid deterioration of renal functions appeared.