Anti-GBM disease in pregnancy

BMJ Case Rep. 2024 Apr 30;17(4):e257767. doi: 10.1136/bcr-2023-257767.

Abstract

We present the case of a pregnant woman in her 20s who presented in her second trimester with severe pulmonary haemorrhage and dialysis-dependent acute kidney failure due to antiglomerular basement membrane (GBM) disease. Responding to therapy, she recovered kidney function and delivered a baby. During her pregnancy, she developed cytomegalovirus viraemia, gestational diabetes and pre-eclampsia. Here, we report the first combined use of cyclophosphamide, rituximab and intensified plasma exchange in anti-GBM disease in pregnancy, allowing minimal exposure to cytotoxic medication, resulting in live birth and dialysis independence.

Keywords: Dialysis; Obstetrics, gynaecology and fertility; Renal medicine; Vasculitis.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / etiology
  • Adult
  • Anti-Glomerular Basement Membrane Disease* / complications
  • Anti-Glomerular Basement Membrane Disease* / diagnosis
  • Anti-Glomerular Basement Membrane Disease* / therapy
  • Cyclophosphamide* / therapeutic use
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Plasma Exchange / methods
  • Pregnancy
  • Pregnancy Complications* / drug therapy
  • Rituximab / therapeutic use

Substances

  • Cyclophosphamide
  • Rituximab
  • Immunosuppressive Agents