Recovery of renal function in a dialysis-dependent patient with microscopic polyangiitis and both myeloperoxidase anti-neutrophil cytoplasmic antibodies and anti-glomerular basement membrane antibodies.

A 40-year-old man with microscopic polyangiitis developed both myeloperoxidase anti-neutrophil cytoplasmic antibodies (90 EU) and anti-glomerular basement membrane antibodies (134 EU)-positive rapidly progressive glomerulonephritis and heparin-induced thrombocytopenia. Although the patient initially showed no signs of improvement, persistent therapy including 1 g/day intravenous methylprednisolone, 50 mg/day oral prednisolone, plasma exchange, and 900 mg/day intravenous cyclophosphamide resulted in the normalization of both titers, recovery of renal function, and discontinuation of dialysis. Though previous studies showed poor outcomes in such "double-positive" patients, aggressive immunosuppression in younger patients may result in the recovery of renal function, even in those with severe renal dysfunction.