Atypical crescentic glomerulonephritis and interstitial lung
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A 70-year-old man presented with 1 month of haematuria and mild right-sided flank pain. He described his urine as first appearing ‘muddy red’ 1 month ago with no change in frequency of voiding or volume of urination from his baseline. He denied seeing any blood clots in the urine, experiencing dysuria, or new onset incontinence. In the emergency department (ED), a Foley catheter was placed, and pink urine was noted in the bag. In addition, he denied all other symptoms during an extensive review of symptoms including haemoptysis, shortness of breath, chest pain and fever.

His medical history is most significant for prostate cancer treated with prostatectomy 4 years ago, followed by recurrence and treatment with 4 months of radiation therapy completed 2 weeks prior to admission. In addition, he has a history of stage III chronic kidney disease (CKD), hypothyroidism, vitiligo, hypertension, gastro-oesophageal reflux disease and gout. CBC, non- contrast CT of abdomen and pelvis, multiple other investigations and kidney biopsy was performed.

This case was a true diagnostic dilemma, especially since most clinicians are familiar with the already rare condition colloquially known as Goodpasture’s disease, but not the more unusual cases of glomerulonephritis such as in this patient. Insights from this case may assist other clinicians in diagnosing unique presentations of glomerulonephritis and formulating treatment plans for patients on immunosuppressive therapy.

Source: BMJ case reports

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