Introduction:
According to national guideline of diabetes mellitus (DM) published in 2021, nearly 13.1 million persons are suffering from DM in Bangladesh1. Diabetic nephropathy (DN) is a major cause of morbidity and mortality in diabetic patients and DN develops in about 40% of type 2 DM patients2,3. Kidney biopsies are performed less frequently in patients with DM and are generally carried out in patients with atypical clinical and laboratory features. Studies have suggested that non-diabetic renal disease (NDRD) is common in diabetic patients, ranging from 20% to 30% among patients undergoing renal biopsy. Among the (NDRD), IgA nephropathy and membranous nephropathy are more prevalent4. In DN, ANCA mediated GN is very rarely encountered5.
Methods:
Here we present a case of ANCA mediated RPGN on top of diabetic nephropathy, a case report.
Results:
A 60-year male presented with swelling of both legs, anorexia and rapidly raising serum creatinine level. He is a known case of DM but duration of DM was not known. On investigation he was found with urine for protein-3+, RBC- 15-20/HPF and 24 hours urinary protein- 8.47 Gm. His serum creatinine on admission was 3.9 mg/dl. He had normal serum C3 and C4 level. His serum for ANA was negative. His serum for p-ANCA was negative but c-ANCA was strongly positive. His HBsAg and anti HCV were negative. He was undergone biopsy. On paraffin section he had 12 glomeruli, of which 07 were globally sclerosed. Among the non-sclerosed one had fibro cellular crescent. All the glomeruli had changes of diabetic nephropathy including glomerular basement membrane (GBM) thickening with mesangial expansion, hyalinosis, hyaline caps and capsular drops, which were PAS positive. Tubular basement membrane was also thickened. There was neutrophilic accumulation in some of the tubules with acute tubular injury. Interstitial fibrosis and tubular atrophy were 30%. On direct immunofluorescence study no deposit of IgG, IgA, IgM, C3, C1q, Kappa or Lambda was found. However, there was linear accentuation of the IgG along the GBM.
Conclusions:
Renal biopsy is performed in diabetic patients preferably to find out the association non diabetic renal disease. IgA nephropathy, membranous nephropathy, infection related renal disease and FSGS are commonly encountered. Here we have presented a case of ANCA mediated pauci- immune glomerulopathy with crescent formation on top of diabetic nephropathy, which is very rare in world literature.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.