Anti-glomerular Basement Membrane Antibody Disease Presenting as Acute Renal Failure During Pregnancy.

A 30-year-old seventh gravida presented with acute renal failure at 28 weeks of gestation. All her previous pregnancies were normal. With a differentional diagnosis of acute pyelonephritis, acute interstitial nephritis (cefuroxime induced) or rapidly progressive glomerulonephritis, treatment with antibiotics, intensive hemodialysis (HD) and pulse methylprednisolone followed by oral prednisolone was initiated. She was maintained on HD 5-6 times per week aiming at serum urea level of less than 15 mmol/L. After six weeks on HD, she underwent a cesarean section at 34 weeks of gestation with delivery of a baby weighing 1.6 kg. Percutaneous left renal biopsy performed one week post-delivery showed anti-glomerular basement membrane (GBM) antibody-mediated crescentic glomerulonephritis. The anti-GBM antibody, which was negative during pregnancy, was found to be positive at this juncture and remained so until ten months post-delivery while on HD. The patient continues to be on regular maintenance HD.