An Unusual Presentation of Pauci-Immune Necrotizing Glomerulonephritis.

Content Provider	Europe PMC
Author	Talon, Andrew Tazi, Nina
Editor	Muacevic, Alexander Adler, John R
Copyright Year	2020
Abstract	Renal-limited pauci-immune necrotizing glomerulonephritis presenting as acute encephalopathy is a rare occurrence. A 67-year-old Hispanic male presented to the hospital after being found down. He was found to have acute renal failure and high anion gap metabolic acidosis. Hemodialysis did not improve his encephalopathy. A vasculitis workup resulted in a high antimyeloperoxidase (MPO) antibody level. Renal biopsy revealed globally sclerotic glomeruli with focal thickened capillary loops, suggestive of pauci-immune necrotizing and crescentic glomerulonephritis (GN). Treatment consisted of high dose methylprednisolone and rituximab for induction, and three cycles of plasmapheresis, in addition to hemodialysis for uremia. Upon discharge, he was continued on hemodialysis and continued treatment with prednisone. Patients who present acutely with persistent uremic encephalopathy despite hemodialysis may warrant pursuing an alternative diagnosis, such as glomerulonephritis. Prompt diagnosis and treatment are necessary to improve the prognosis since untreated pauci-immune glomerulonephritis carries a high mortality rate.
Journal	Cureus
Volume Number	12
DOI	10.7759/cureus.12155
PubMed Central reference number	PMC7811886
Issue Number	12
PubMed reference number	33489567
e-ISSN	21688184
Language	English
Publisher	Cureus
Publisher Date	2020-12-18
Publisher Place	Palo Alto (CA)
Access Restriction	Open
Subject Keyword	acute renal failure encephalopathy rapidly progressive glomerulonephritis pauci-immune vasculitis mpo-anca p-anca renal-limited crescentic glomerulonephritis uremic encephalopathy
Content Type	Text
Resource Type	Case study
Subject	Medicine