Rapidly progressive glomerulonephritis revealing the coexistence of diabetic nephropathy, membranous nephropathy, and MPO-ANCA-associated crescentic glomerulonephritis.
- 1Department of Nephrology, Dialysis, and Kidney Transplantation, Mongi Slim Hospital.
- 2Faculty of Medicine, University of Tunis El Manar, and.
- 3Laboratory of Renal Pathology, Charles Nicolle Hospital, Tunis, Tunisia.
Abstract
Diabetic nephropathy (DN) is the leading cause of chronic kidney disease worldwide. However, Patients with diabetes presenting with atypical renal manifestations may harbor superimposed non-diabetic kidney disease, making kidney biopsy essential for accurate diagnosis. Although cases of DN coexisting with either membranous nephropathy (MN) or MPO-ANCA-associated vasculitis have been reported, the concurrent occurrence of all three entities is exceptionally rare. We report the case of a 59-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus, diabetic retinopathy, hypertension, and chronic kidney disease attributed to DN, who presented with rapidly progressive kidney dysfunction. Serum creatinine increased from a baseline of ~ 220 to 560 μmol/L, accompanied by nephrotic-range proteinuria (9 g/day) and microscopic hematuria. Immunological testing demonstrated strongly positive MPO-ANCA (120 U/mL by ELISA), whereas PR3-ANCA, anti-glomerular basement membrane, antinuclear, and anti-phospholipase A2 receptor antibodies were negative. Kidney biopsy demonstrated nodular diabetic glomerulosclerosis, membranous nephropathy, and pauci-immune crescentic glomerulonephritis consistent with MPO-ANCA-associated vasculitis. Treatment with intravenous methylprednisolone, oral prednisone, and two 1-g infusions of rituximab resulted in partial recovery of kidney function, allowing discontinuation of temporary hemodialysis and stabilization of serum creatinine at ~ 300 μmol/L. This case highlights the indispensable role of kidney biopsy in diabetic patients with rapidly progressive kidney dysfunction and illustrates the diagnostic and therapeutic implications of identifying multiple coexisting glomerular diseases.
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BibTeX
@article{hadded2026rapidly,
title = {{Rapidly progressive glomerulonephritis revealing the coexistence of diabetic nephropathy, membranous nephropathy, and MPO-ANCA-associated crescentic glomerulonephritis.}},
author = {Sarra Hadded and Rania Kandil and Hanene Gaied and Marwa Trabelsi and Raja Aoudia and Meriam Khadhar and Mouna Jerbi and Rim Goucha},
journal = {Clinical nephrology. Case studies},
year = {2026},
month = oct,
doi = {10.5414/cncs112223},
url = {https://europepmc.org/article/MED/42903493},
note = {CC BY},
}
RIS
TY - JOUR
TI - Rapidly progressive glomerulonephritis revealing the coexistence of diabetic nephropathy, membranous nephropathy, and MPO-ANCA-associated crescentic glomerulonephritis.
AU - Sarra Hadded
AU - Rania Kandil
AU - Hanene Gaied
AU - Marwa Trabelsi
AU - Raja Aoudia
AU - Meriam Khadhar
AU - Mouna Jerbi
AU - Rim Goucha
PY - 2026
DA - 2026/10/13
JO - Clinical nephrology. Case studies
DO - 10.5414/cncs112223
UR - https://europepmc.org/article/MED/42903493
AB - Diabetic nephropathy (DN) is the leading cause of chronic kidney disease worldwide. However, Patients with diabetes presenting with atypical renal manifestations may harbor superimposed non-diabetic kidney disease, making kidney biopsy essential for accurate diagnosis. Although cases of DN coexisting with either membranous nephropathy (MN) or MPO-ANCA-associated vasculitis have been reported, the concurrent occurrence of all three entities is exceptionally rare. We report the case of a 59-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus, diabetic retinopathy, hypertension, and chronic kidney disease attributed to DN, who presented with rapidly progressive kidney dysfunction. Serum creatinine increased from a baseline of ~ 220 to 560 μmol/L, accompanied by nephrotic-range proteinuria (9 g/day) and microscopic hematuria. Immunological testing demonstrated strongly positive MPO-ANCA (120 U/mL by ELISA), whereas PR3-ANCA, anti-glomerular basement membrane, antinuclear, and anti-phospholipase A2 receptor antibodies were negative. Kidney biopsy demonstrated nodular diabetic glomerulosclerosis, membranous nephropathy, and pauci-immune crescentic glomerulonephritis consistent with MPO-ANCA-associated vasculitis. Treatment with intravenous methylprednisolone, oral prednisone, and two 1-g infusions of rituximab resulted in partial recovery of kidney function, allowing discontinuation of temporary hemodialysis and stabilization of serum creatinine at ~ 300 μmol/L. This case highlights the indispensable role of kidney biopsy in diabetic patients with rapidly progressive kidney dysfunction and illustrates the diagnostic and therapeutic implications of identifying multiple coexisting glomerular diseases.
SN - 2196-5293
ER -