ACUTE-RENAL-FAILURE IN MEMBRANOUS GLOMERULONEPHROPATHY - A RESULT OF SUPERIMPOSED CRESCENTIC GLOMERULONEPHRITIS

A patient who presented with acute renal failure and anasarca secondar y to crescentic glomerulonephritis superimposed on existing membranous glomerulonephropathy of 15 years' duration is described. The patient responded to an initial course of prednisone but failed to respond to a second course after relapse, The differential diagnosis of acute ren al failure in the setting of nephrotic syndrome is discussed. Eighteen cases of crescentic glomerulonephritis superimposed on membranous glo merulonephropathy are reviewed. The clinical setting is heterogeneous with variable presentation and outcome, It appears that patients witho ut antiglomerular basement membrane antibodies have a better prognosis than those who have antibodies. Patients with membranous glomerulonep hropathy who develop unexplained acute renal failure should undergo ea rly renal biopsy in order to rule out unexpected pathologic complicati ons.