article
Antibrush border antibody disease: a case report and literature review
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Autor
Almeida, Jose Bruno de
Brito, Laíse Pereira Arcoverde Fechine
Guedes, Felipe Leite
Vale, Pedro Henrique Cavalcante
Santos, Rivaldo Pereira
Martins, Sílvia Queiroz Santos
Dantas, Gleiko Yuri de Figueredo
Wanderley, David
Araújo, Stanley de Almeida
Silva, Gyl Eanes Barros
Resumen
Anti-brush border antibody (ABBA) disease, also called anti–low-density lipoprotein receptor-related protein 2 (anti-LRP2) nephropathy, occurs due to the formation of antibodies against brush border antigens of the renal proximal convoluted tubule. We report a case of ABBA disease in a male farmer in his 30s who presented with 2 years of polyuria, dysuria, nocturia, and urinary urgency. He described a history of long-term occupational exposure to pesticides and silica, evolving into possible pneumoconiosis, and prior pulmonary tuberculosis. At presentation, he had reduced kidney function (serum creatinine 3.6 mg/dL) with hyponatremia, hypokalemia, hypophosphatemia, a normal anion gap, metabolic acidosis, and respiratory acidosis, and 2.2 g/day of urine proteinuria. The kidney biopsy was consistent with ABBA, showing amorphous immune-deposits in the tubular basement membrane and strong positivity on indirect immunofluorescence in the brush border of the proximal tubules. The trigger for production of ABBA is still unknown, but it may be associated with chronic conditions such as pulmonary tuberculosis and occupational exposures such as silica and pesticides, as seen in the patient in this report. Most cases do not respond to immunosuppression, and the prognosis is poor.