Portinari G1,*, Migali G2, Vasconcelos LC3
1UCLouvain, Brussels, Belgium
2Nephrology department, CHU UCL-Namur, site Namur, Belgium
3UCLouvain, Brussels, Belgium
*Corresponding author: Giacomo Portinari, UCLouvain, Brussels, Belgium; Email: [email protected]
Received Date: January 07, 2023
Published Date: January 24, 2023
Citation: Portinari G, et al. (2023). Immune Complex Glomerulonephritis and Elevated p-ANCA Overlap Syndrome in a 58-Year-Old Patient with Rapidly Progressive Kidney Failure. Mathews J Case Rep. 8(1):83.
Copyrights: Portinari G, et al. © (2023).
A 58-year-old man was referred by his family physician for assessment of macroscopic haematuria, leukocyturia, hypertension, and subacute renal failure. On admission, serum creatinine level was 3.39mg/dL and physical examination did not show anything out of the ordinary. Initial tests that showed massive proteinuria (11.83g/24h), significant haematuria (4081rbc/µL) with presence of dysmorphic red blood cells, leukocyturia (64 wbc/µL) with negative bacterial culture, elevated p-ANCA levels (197.7 UI/mL). Renal biopsy results showed a rapidly progressive immune-complex glomerulonephritis with a majority of IgG2 deposits. Secondary causes of immuno-complex glomerulonephritis were extensively searched and excluded. Initial treatment was administered following the p-ANCA glomerulonephritis treatment guidelines (corticoid pulse therapy and cyclophosphamide). Creatinine levels answered poorly to this treatment and the patient ended up needing haemodialysis. A new therapy following the PEXIVAS trial was started at the Cliniques Universitaires St-Luc in Brussels. The patient is nowadays still undergoing haemodialysis, with poor renal function prognosis. Given the surprising presence of both immune complexes and p-ANCA in renal biopsies and the poor answer to the first line treatments of p-ANCA glomerulonephritis, immune complex and p-ANCA overlap syndrome may be evoked as a likely diagnosis.
Keywords: Glomerulonephritis, ANCA, Vasculitis, Overlap Syndrome, PEXIVAS Trials.