Rapidly Progressive Glomerulonephritis Due to ANCA-Associated Glomerulonephritis in a Patient with Diabetic Nephropathy: A Case Report

Abstract

Background
Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome marked by a rapid decline in kidney function over a short period, typically days to weeks, and is commonly associated with crescent formation on renal histopathology. In individuals with diabetic nephropathy, differentiating superimposed glomerular disease from the natural progression of chronic kidney disease (CKD) can be difficult due to overlapping clinical features.

Objective

To describe ANCA-associated glomerulonephritis presenting as rapidly progressive glomerulonephritis in a patient with diabetic nephropathy and emphasize early diagnosis.

Case-Presentation
A 56-year-old woman with a history of type 2 diabetes mellitus, hypertension, and CKD presented with dysuria, reduced urine output, generalized edema, and systemic symptoms. Laboratory investigations revealed a sharp increase in serum creatinine, necessitating urgent initiation of hemodialysis. Urinalysis demonstrated active sediment including hematuria and proteinuria, and serological testing was positive for c-ANCA. Renal biopsy findings were consistent with crescentic glomerulonephritis, confirming ANCA-associated glomerulonephritis superimposed on diabetic nephropathy.

Conclusion
This case underlines the need for early recognition of ANCA-associated glomerulonephritis presenting as RPGN in diabetic patients with atypical clinical features and highlights the critical role of renal biopsy and timely immunosuppressive therapy.