Crescentic glomerular nephritis associated with rheumatoid arthritis: a case report

• Published in: Journal of medical case reports 2017-07, Vol.11 (1), p.197-197, Article 197
• Main Authors: Balendran, K, Senarathne, L D S U, Lanerolle, R D
• Format: Article
• Language: English
• Subjects: Abdomen; Antibodies, Antineutrophil Cytoplasmic - blood; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - immunology; Biopsy; Blood Sedimentation; Case Report; Case reports; Crescentic glomerular nephritis; Deoxyribonucleic acid; DNA; Edema; Edema - etiology; Female; Glomerulonephritis; Glomerulonephritis - complications; Glomerulonephritis - diagnosis; Hepatitis; HIV; Human immunodeficiency virus; Humans; Kidney - immunology; Kidney - pathology; Kidney diseases; Laboratories; Methotrexate - therapeutic use; Middle Aged; Patients; Proteins; Proteinuria - urine; Rheumatoid arthritis; Rheumatoid nephropathies; Risk factors; Ultrasonic imaging; Urine
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-017-1346-8

Rheumatoid arthritis is a systemic disorder where clinically significant renal involvement is relatively common. However, crescentic glomerular nephritis is a rarely described entity among the rheumatoid nephropathies. We report a case of a patient with rheumatoid arthritis presenting with antineutrophil cytoplasmic antibody-negative crescentic glomerular nephritis. A 54-year-old Sri Lankan woman who had recently been diagnosed with rheumatoid arthritis was being treated with methotrexate 10 mg weekly and infrequent nonsteroidal anti-inflammatory drugs. She presented to our hospital with worsening generalized body swelling and oliguria of 1 month's duration. Her physical examination revealed that she had bilateral pitting leg edema and periorbital edema. She was not pale or icteric. She had evidence of mild synovitis of the small joints of the hand bilaterally with no deformities. No evidence of systemic vasculitis was seen. Her blood pressure was 170/100 mmHg, and her jugular venous pressure was elevated to 7 cm with an undisplaced cardiac apex. Her urine full report revealed 2+ proteinuria with active sediment (dysmorphic red blood cells [17%] and granular casts). Her 24-hour urinary protein excretion was 2 g. Her serum creatinine level was 388 μmol/L. Abdominal ultrasound revealed normal-sized kidneys with acute parenchymal changes and mild ascites. Her renal biopsy showed renal parenchyma containing 20 glomeruli showing diffuse proliferative glomerular nephritis, with 14 of 20 glomeruli showing cellular crescents, and the result of Congo red staining was negative. Her rheumatoid factor was positive with a high titer (120 IU/ml), but results for antinuclear antibody, double-stranded deoxyribonucleic acid, and antineutrophil cytoplasmic antibody (perinuclear and cytoplasmic) were negative. Antistreptolysin O titer