# Concurrent anti-glomerular basement membrane disease and membranous nephropathy: a case report

## TL;DR

A rare case of two kidney diseases occurring together is reported, showing how timely treatment can lead to recovery.

## Contribution

This case report highlights the concurrent occurrence of anti-GBM disease and membranous nephropathy, a rare clinical scenario.

## Key findings

- The patient showed crescentic and necrotizing glomerulonephritis with linear IgG staining and high anti-GBM antibody levels.
- Renal biopsy revealed granular PLA2R staining along the GBM, indicating membranous nephropathy.
- Treatment with prednisone, plasmapheresis, and CD20 antibodies led to antibody clearance and renal recovery.

## Abstract

Anti-glomerular basement membrane (GBM) disease is a rapidly progressive glomerulonephritis which, in rare instances, occurs concurrently with membranous nephropathy (MN). We report a case of this patient presented with proteinuria and hematuria, the predominant pathology was crescentic and necrotizing glomerulonephritis with linear staining for immunoglobulin G (IgG) along the glomerular basement membrane (GBM) associated with epi-membranous electron dense immune deposits. The patient tested had significant titers of anti-GBM antibodies (196.27 RU/ml; reference range:0–20 RU/ml), and renal biopsy demonstrated diffuse strongly positive granular staining for phospholipase a2 receptor (PLA2R) along the GBM. The patient received therapy including prednisone, plasmapheresis and CD20 antibodies, which resulted in the clearance of anti-GBM antibodies and eventual recovery of renal function, as evidenced by the return of serum creatinine to normal levels. Earlier diagnosis and timely effective treatments could improve patients' prognosis.