Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 404-409
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.404
Goodpasture syndrome and hemorrhage after renal biopsy: A case report
Wei-Long Li, Xi Wang, Shu-Yuan Zhang, Zi-Gan Xu, Ying-Wei Zhang, Xing Wei, Chun-Di Li, Ping Zeng, Shao-Dong Luan
Wei-Long Li, Xi Wang, Shu-Yuan Zhang, Zi-Gan Xu, Ying-Wei Zhang, Xing Wei, Chun-Di Li, Ping Zeng, Shao-Dong Luan, Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
Author contributions: Li WL supervised the study, reviewed the literature, and contributed to manuscript drafting; Wang X, Zhang SY, Xu ZG, Zhang YW, and Li CD collected the information from the patient; Wei X and Luan SD were surgeons for biopsy and revised the manuscript; All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shao-Dong Luan, PhD, Chief Doctor, Department of Nephrology, Shenzhen Longhua District Central Hospital, 187 Guanlan Road, Shenzhen 518110, Guangdong Province, China. szkidney3@163.com
Received: November 14, 2019
Peer-review started: November 14, 2019
First decision: December 12, 2019
Revised: December 18, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: January 26, 2020
Processing time: 62 Days and 18.4 Hours
Abstract
BACKGROUND

Goodpasture syndrome (GS) is a rare disease, the morbidity of which is estimated to be 0.5-0.8 per million per year. Hemorrhage is the most serious complication in renal biopsy. Despite the fact that both GS and hemorrhage after renal biopsy are rare, it has not been reported that they are likely to occur in the same patient.

CASE SUMMARY

A 30-year-old man with diffuse pulmonary hemorrhage and rapid progressive renal function caused by anti-glomerular basement membrane disease presented atypical symptoms without hemoptysis, accompanied by life-threatening hypoxemia. Plasmapheresis was performed, and glucocorticoids and cyclophosphamide were administered. The patient started to show signs of improvement. Percutaneous renal biopsy is an appropriate diagnostic measure that is commonly safe, but this patient experienced hemorrhage after operation, thus necessitating embolization of the renal artery to stop the bleeding. The patient’s condition was improved, and the serum anti-glomerular basement membrane antibody level was 106 AU/mL (normal range: < 24 AU/mL) and slowly decreased. His discharge medications were oral daily prednisone (30 mg) and continued maintenance hemodialysis.

CONCLUSION

GS is a rare organ-specific autoimmune disease that is invariably ubiquitous in the lung and kidney areas. Renal biopsy is the appropriate procedure for the treatment of GS disease, although it is an invasive measure.

Keywords: Goodpasture disease; Anti-glomerular basement membrane disease; Renal biopsy; Hemorrhage; Glomerular basement membrane; Case report

Core tip: Goodpasture syndrome was first identified by Dr. Ernest Goodpasture, who described it as an association between alveolar hemorrhage and glomerulonephritis. We report on a young male patient with life-threatening pulmonary hemorrhage without hemoptysis, accompanied by hemorrhage after renal biopsy. This case highlights the critical importance of prompt diagnosis and initiation of therapy. However, preventive measures, such as the addition of fresh plasma, should be considered to decrease the incidence of hemorrhage in similar situations, especially for dialysis patients.