Antiglomerular basement membrane antibody-mediated glomerulonephritis after intranasal cocaine use

We report a case of rapidly progressive glomerulonephritis due to antiglome rular basement membrane (anti-GBM) antibodies that progressed to end-stage renal disease in a 35-year-old man who used intranasal cocaine on an occasi onal basis. In contrast to many prior reports of acute renal failure occurr ing with cocaine-associated rhabdomyolysis, this patient did not have any e vidence of acute muscle damage and myoglobin release. Circulating anti-GEM antibodies and renal biopsy with linear IgG and C3 deposits confirmed the d iagnosis of anti-GBM disease. The possibility of anti-GEM must be considere d in the differential diagnosis of acute renal failure in cocaine addicts. This unusual combination raises complex questions regarding the pathogenesi s of this type of renal injury.