Sequential development of pulmonary hemorrhage with MPO-ANCA complicating anti-glomerular basement membrane antibody-mediated glomerulonephritis

We report a case of rapidly progressive glomerulonephritis caused by anti-g lomerular basement membrane (anti-GBM) antibodies that progressed to end st age renal disease in a 67-year-old woman with diabetes. Intensive combined immunosuppressive therapy with methylprednisolone bolus, oral prednisone, a nd cyclophosphamide led to negativity of anti GBM antibodies but was not ab le to restore renal function. After 28 months of hemodialysis, the patient suddenly presented with pulmonary hemorrhage. In this setting, high levels of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) and neg ative anti-GEM antibodies were found. Therapy with oral prednisone and cycl ophosphamide led to resolution of pulmonary hemorrhage and negativity of MP O-ANCA. (C) 2000 by the National Kidney Foundation, Inc.