Anti-glomerular Basement Membrane Glomerulonephritis During the First Trimester of Pregnancy

Kai, Hirayasu; Usui, Joichi; Tawara, Takashi; Takahashi-Kobayashi, Mayumi; Ishii, Ryota; Tsunoda, Ryoya; Fujita, Akiko; Nagai, Kei; Kaneko, Shuzo; Morito, Naoki; Saito, Chie; Hamada, Hiromi; Yamagata, Kunihiro

doi:10.2169/internalmedicine.5722-20

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…To our knowledge, this is the frst case of atypical anti-GBM disease in pregnant patients with suspected systemic lupus erythematosus reported in the literature, and to date, there are only approximately ten case reports of anti-GBM antibody glomerulonephritis in pregnant patients [5][6][7][8][9][10], and only two of them are negative against anti-GBM antibodies [8,9]. Al-Harbi et al reported a 30-year-old woman with acute renal failure at 28 weeks of gestation, whose repeat anti-GBM antibody test in a serum sample taken after delivery was positive [8].…”

Section: Discussionmentioning

confidence: 87%

Atypical Antiglomerular Basement Membrane Disease in a Pregnant Patient with Systemic Lupus Erythematosus

Ounhasuttiyanon,

Tantranont,

Srithongkul

2023

Case Reports in Nephrology

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Antiglomerular basement membrane disease (anti-GBM) is an unusual cause of glomerulonephritis. Patients usually present with rapidly progressive glomerulonephritis with or without pulmonary hemorrhage. The diagnosis is based on linear deposits of IgG along the GBM and the presence of anti-GBM antibodies. However, cases with atypical anti-GBM disease in which an anti-GBM antibody was not detected have been reported. We report a 29-year-old pregnant woman with underlying systemic lupus erythematosus (SLE) who presented with severe glomerulonephritis due to atypical antiglomerular basement membrane disease. She was initially diagnosed with active lupus nephritis and her renal function gradually worsened after steroid treatment, so the pregnancy was terminated due to the high maternal and fetal risks. A kidney biopsy showed linear capillary wall staining with fibrous crescents without endocapillary proliferation. The anti-GBM antibody showed negative results two times, so she was diagnosed with atypical anti-GBM disease. Treatment began with intravenous pulse methylprednisolone and continued with mycophenolate mofetil and prednisolone. Due to the intolerability of side effects, the treatment regimen was subsequently changed to intravenous cyclophosphamide. Although she had a significant improvement in clinical edema, serum albumin, and hematuria, her renal function gradually decreased during the 12 months of treatment. A review of the literature showed that the atypical anti-GBM is less aggressive than the typical anti-GBM disease. However, several patients had persistent renal dysfunction and 20–30% of patients had progression to ERSD. To the best of our knowledge, this is the first case of atypical anti-GBM disease in pregnant patients with suspected SLE reported in the literature.

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Section: Discussionmentioning

confidence: 87%

Atypical Antiglomerular Basement Membrane Disease in a Pregnant Patient with Systemic Lupus Erythematosus

Ounhasuttiyanon,

Tantranont,

Srithongkul

2023

Case Reports in Nephrology

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“…This condition raised the question of whether there was any association between the pregnancy and anti-GBM disease. Kai et al [ 16 ] reported a case of a 28-year-old female who was diagnosed with anti-GBM glomerulonephritis during the first trimester of pregnancy. The edema occurred as early as the fifth week.…”

Section: Discussionmentioning

confidence: 99%

“…To date, anti-GBM disease occurring during gestation had only been reported in a few cases. [9][10][11][12][13][14][15][16][17][18] Patients with newly formed bilateral large corpus luteum cysts in patients with anti-GBM disease and pregnancy were not reported.…”

Section: Discussionmentioning

confidence: 99%

Anti-glomerular basement membrane disease with rupture of the newly formed bilateral corpus luteum cysts: A case report

et al. 2022

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Rationale: Anti-glomerular basement membrane (anti-GBM) disease during gestation is sparse and even rarer when combined with bilateral large corpus luteum cysts. In this case, we report a case of anti-GBM disease in the early stage of pregnancy with ruptured newly formed bilateral large corpus luteum cysts.Patient concerns: A 24-year-old female was initially diagnosed with anti-GBM disease. During treatment, abdominal distention and vaginal bleeding successively staged. The results of the first gynecological ultrasound and abdominal CT were negative.Diagnosis: Based on the dynamic imaging change of the ovaries, the elevated human chorionic gonadotropin (hCG) and sex hormones, and the pathological findings, a diagnosis of anti-GBM disease with rupture of the newly formed bilateral corpus luteum cysts during early pregnancy was considered. Interventions:The patient was treated with corticosteroids, plasma-exchange along with intensive hemodialysis. Then, to confirm the diagnosis, laparoscopic debulking of bilateral ovarian cysts and curettage were performed.Outcomes: After treatment, the anti-GBM antibody titer declined and the condition of the patient was still stable 2 months following discharge.Lessons: As clinicians, we should be aware that even if the first imaging tests are negative, the relevant indicators should be reviewed dynamically based on the condition of the patients. Additionally, this case raised the question of whether anti-GBM disease was associated with pregnancy and giant corpus luteum cysts, which needs further investigations.Abbreviations: anti-GBM = anti-glomerular basement membrane, CT = computed tomography, hCG = human chorionic gonadotropin.

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Anti-glomerular basement membrane disease complicated by malaria during pregnancy with successful maternal and fetal outcomes: a case report

Jafry,

Butt,

Mubarak

et al. 2024

J Nephrol

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Anti-glomerular Basement Membrane Glomerulonephritis During the First Trimester of Pregnancy

Cited by 3 publications

References 19 publications

Atypical Antiglomerular Basement Membrane Disease in a Pregnant Patient with Systemic Lupus Erythematosus

Atypical Antiglomerular Basement Membrane Disease in a Pregnant Patient with Systemic Lupus Erythematosus

Anti-glomerular basement membrane disease with rupture of the newly formed bilateral corpus luteum cysts: A case report

Anti-glomerular basement membrane disease complicated by malaria during pregnancy with successful maternal and fetal outcomes: a case report

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