A case report of the anti-glomerular basement membrane glomerulonephritis with mesangial IgA deposition

Abstract

A 46-year-old Japanese male with a past medical history of microscopic hematuria presented with nausea, vomiting, and abdominal pain for which he had been diagnosed with rapidly progressive glomerulonephritis with a peak serum creatinine of 6.6 mg/dL and anti-glomerular basement membrane antibody of 214 EU. Light microscopy showed cellular crescent formation, and immunofluorescence illustrated both linear staining of IgG along the glomerular basement membrane and granular staining of IgA and C3 in the mesangial area; however, the PAS staining of mesangial expansions and mesangial proliferations were not observed. Clinical and histological findings suggested anti-glomerular basement membrane glomerulonephritis with mesangial IgA deposition, suggesting IgA nephropathy, a rare condition.

Keywords: Anti-glomerular basement membrane glomerulonephritis; IgA nephropathy; Rapidly progressive glomerulonephritis.

Fig. 1

Light micrograph of weak magnification shows diffuse crescentic formation and few residual glomerular tufts. Significant mesangial expansion was not detected. PAS (×10)

Fig. 2

Glomerulus showed cellular crescents and the basement membranes were fragmented (arrow). PAS (×100)

Fig. 3

Two staining patterns from the patient: linear immunofluorescence for IgG along the glomerular capillary walls (left) and mesangial staining for IgA (right)

Fig. 4

Glomerulus showing the wrinkling and irregularity of the GBM (×1,200)

Fig. 5

Clinical course of the patient