A case report of concomitant anti-glomerular basement membrane disease, IgA nephropathy, and membranous nephropathy

The coexistence of anti-glomerular basement membrane (anti-GBM) disease, IgA nephropathy (IgAN), and membranous nephropathy (MN) represents an exceptionally rare glomerular pathology triad, with only one previously documented case. This study explores the underlying mechanisms linking these distinct entities and reports a novel case associated with persistent elevation of serum amylase and lipase, thereby expanding the clinical spectrum of this complex disease combination. A 51-year-old woman presenting with recurrent macroscopic hematuria and rapidly progressive renal dysfunction was diagnosed with simultaneous triple glomerulopathy based on positive anti-GBM antibodies and renal biopsy findings. An integrated therapeutic regimen was administered, including high-dose methylprednisolone pulse therapy, cyclophosphamide, intensive plasma exchange (PE), and hemodialysis. Treatment led to undetectable anti-GBM antibody titers within two months, successful discontinuation of hemodialysis by the third month, and complete resolution of hematuria. By the ten-month follow-up, proteinuria and serum creatinine levels significantly decreased, renal function stabilized with normal urine output, and no significant adverse events were observed. This case demonstrates the pathological coexistence of triple glomerulopathy. Although clinical improvement was observed after a combined regimen of early PE and immunosuppression, causality cannot be inferred from a single case. These findings provide hypothesis-generating insights for the management of similar complex cases and highlight the need for further research.