Anti-GBM/ANCA double-positive crescentic nephritis in an elderly patient presenting with heart failure-like symptoms: A case report.
Meijuan Shi, Guoqing Shi, Hongmei Liu et al.
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Case in brief
A 74-year-old woman presented with progressive shortness of breath, nausea, and vomiting, initially raising concern for heart failure. Testing instead showed severe renal impairment (creatinine 1025.99 μmol/L). Biopsy revealed crescents in over 80% of glomeruli and linear IgG along glomerular capillary loops; serology showed anti-GBM antibody >400 RU/mL and MPO-ANCA positivity. She received methylprednisolone, cyclophosphamide, plasma exchange, and supportive care. Uremic symptoms improved and both antibody tests later became negative, but kidney function did not recover. She remained dialysis-dependent, transitioning from hemodialysis to peritoneal dialysis.
What made this case unusual
The presentation mimicked heart failure, while biopsy and serology established anti-GBM nephritis with MPO-ANCA positivity. Despite symptomatic and serological improvement after treatment, renal function remained dialysis-dependent.
Diagnostic / clinical pearl
In an older patient with nonspecific symptoms, severe or rapidly worsening renal impairment should prompt consideration of glomerulonephritis even when the initial presentation suggests a cardiopulmonary cause; biopsy and anti-GBM/ANCA testing clarified the diagnosis here.