RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS AS AN INITIAL MANIFESTATION OF P-ANCA-POSITIVE VASCULITIS: A CASE REPORT

Abstract

This article reports the case of a young woman with rapidly progressive glomerulonephritis (RPGN) as the initial manifestation of p-ANCA-positive vasculitis. Data were obtained through clinical interview, follow-up during hospitalization, and medical record review. A 25-year-old woman with hypertension presented with macroscopic hematuria, gastrointestinal symptoms, and an increase in serum creatinine from 1.6 to 3.6 mg/dL over approximately two weeks, with positive p-ANCA and no respiratory or systemic manifestations. She was hospitalized with suspected vasculitis-associated RPGN and received pulse methylprednisolone, followed by prednisone and cyclophosphamide, the latter started before the renal biopsy result was available. Hematuria resolved and renal function improved, with creatinine of 2.1 mg/dL at discharge and 1.6 mg/dL at the first outpatient visit. The biopsy revealed pauci-immune crescentic glomerulonephritis in a predominantly sclerotic phase, suggesting that kidney damage was already established at the time of diagnosis. This case reinforces that ANCA-associated vasculitis may present as isolated RPGN even in young patients, and that early diagnosis and treatment are essential to preserve renal function.