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Abstract：
This case report discusses the management of anti-neutrophil cytoplasmic antibodies (ANCA)-negative rapid progressive glomerulonephritis (RPGN) in a 68-year-old man with a complex medical history, presenting with fatigue, edema, and acute renal failure. Despite the absence of positive biomarkers for specific RPGN types, the clinical progression suggested microscopic polyangiitis, leading to intensive immunosuppressive therapy with cyclophosphamide and rituximab. The patient\'s condition was further complicated by the coexistence of nephritic and nephrotic syndromes, requiring nuanced management strategies, including prolonged hemodialysis. After initial treatment failure, remission was eventually achieved, allowing cessation of dialysis and significant recovery of renal function. This case highlights the challenges of diagnosing and managing ANCA-negative RPGN, particularly the importance of a tailored, dynamic approach to treatment in resource-limited settings. The recovery observed underscores the potential for renal function improvement even after prolonged periods of intensive therapy, reinforcing the need for persistence and adaptability in managing complex RPGN cases.
摘要：
本病例报告讨论了一名具有复杂病史的68岁男性患者抗中性粒细胞胞浆抗体（ANCA）阴性快速进展性肾小球肾炎（RPGN）的治疗。呈现疲劳，水肿,和急性肾衰竭.尽管没有特定RPGN类型的阳性生物标志物，临床进展提示显微镜下多血管炎，导致环磷酰胺和利妥昔单抗的强化免疫抑制治疗。患者的病情因肾病综合征和肾病综合征的共存而进一步复杂化，需要细致入微的管理策略，包括长时间的血液透析.最初治疗失败后，最终实现了缓解，允许停止透析和肾功能的显着恢复。此案例凸显了诊断和管理ANCA阴性RPGN的挑战，特别是量身定做的重要性，资源有限环境下的动态治疗方法。观察到的恢复强调了肾功能改善的潜力，即使经过长时间的强化治疗，加强管理复杂RPGN病例对持久性和适应性的需求。
