# Anti-neutrophil Cytoplasmic Antibody-Negative Rapid Progressive Glomerulonephritis With Mild Pathological Presentation in an Older Patient: A Case Report

## TL;DR

This case report describes a rare instance of a kidney disease in an older man without typical biomarkers, highlighting the challenges in diagnosis and treatment.

## Contribution

The case emphasizes the importance of tailored treatment approaches for ANCA-negative RPGN in resource-limited settings.

## Key findings

- The patient showed significant renal function recovery after intensive immunosuppressive therapy.
- The case illustrates the complexity of managing RPGN with coexisting nephritic and nephrotic syndromes.
- Successful treatment required a dynamic and persistent approach despite initial treatment failure.

## Abstract

This case report discusses the management of anti-neutrophil cytoplasmic antibodies (ANCA)-negative rapid progressive glomerulonephritis (RPGN) in a 68-year-old man with a complex medical history, presenting with fatigue, edema, and acute renal failure. Despite the absence of positive biomarkers for specific RPGN types, the clinical progression suggested microscopic polyangiitis, leading to intensive immunosuppressive therapy with cyclophosphamide and rituximab. The patient's condition was further complicated by the coexistence of nephritic and nephrotic syndromes, requiring nuanced management strategies, including prolonged hemodialysis. After initial treatment failure, remission was eventually achieved, allowing cessation of dialysis and significant recovery of renal function. This case highlights the challenges of diagnosing and managing ANCA-negative RPGN, particularly the importance of a tailored, dynamic approach to treatment in resource-limited settings. The recovery observed underscores the potential for renal function improvement even after prolonged periods of intensive therapy, reinforcing the need for persistence and adaptability in managing complex RPGN cases.