A case of rapidly progressing glomerulonephritis due to double-positive anti-neutrophil cytoplasmic antibodies and anti-glomerular basement membrane antibodies vasculitis associated with membranous nephropathy treated with selective plasma exchange

Abstract

Rapidly progressing glomerulonephritis (RPGN) due to double-positive anti-neutrophil cytoplasmic antibodies and anti-glomerular basement membrane antibodies vasculitis is characterized by advanced renal damage, poor renal prognosis, and a high probability of relapse. The disease progression is rapid, and prompt therapeutic intervention, including plasma exchange therapy, is important. We report a case of selective plasma exchange (SePE) in addition to oral corticosteroid and cyclophosphamide pulse therapy (IVCY) for RPGN in a patient with crescentic glomerulonephritis. A 79-year-old woman was treated with oral corticosteroids, IVCY, and SePE. We suggest that early immunosuppressive therapy with SePE, which does not require coagulation factor replacement, may be useful in suppressing new antibody production and eliminating antibodies.