The routine evaluation revealed normal renal functions with negligible proteinuria done in late 2019. She presented in July 2020 to her physician with bilateral leg swelling, frothy urine, and early morning puffiness of the face. Preliminary investigation revealed Sr Creatinine Of 3.7 mg/dl, active urine with proteinuria and microscopic hematuria. Urine was sterile on culture. 2 days later, when she presented here, Creatinine had gone up to 5.6 mg/dl, Urine showed protein +4, numerous RBCs, WBCs & Albumin to creatinine ratio (ACR) was >2000.
Suspecting RPGN, she was evaluated. NO e/o Diabetic
Retinopathy as her Creatinine shot up to 6.9mg/dl, empirical IV Pulse Steroids was started. Serology including HIV, HCV, HBV and complements q, ANA & ANCA -‘ were negative. Kidney biopsy was done the next day which showed Anti GBM disease and Sr anti-GBM titre were high @ 1 13 IU/ML .CT thorax was normal, She was immediately started on PO Cyclophosphamide along with plasma exchanges. She responded well and after 7 PLEX along with Cyclophosphamide + steroid, creatinine declined to 2.06 mg/dl. As she developed haematological toxicity, Cyclophosphamide was stopped & she was given 2 doses of IV Rituximab (500 mg) and steroid was tapered Off slowly.6 months into the treatment, she is stable, creatinine is 1.9mg/dl, urine shows no protein or blood and she on the minimum dose of steroids.
This case highlights the following things:
- TO Suspect Non-Diabetic kidney disease(NDKD) in that T2DM.
- Rare presentation of Anti GBM disease in T2DM.
- Despite literature citing poor outcome if initial creatinine is 27.0, our case supports the need for early aggressive treatment which can change the course of disease and outcome.
