Rapidly progressive glomerulonephritis(RPGN) is one of the most calamitous renal disease which is clinically characterized by sudden and relentless deterioration in renal function within weeks to months and associated with the pathologic finding of extensive extracapillary proliferation. Pauci-immune RPGN is mostly associated with anti neutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis, but renal-limited RPGN may be found in part. We experienced a case of ANCA positive RPGN associated with polyclonal gammopathy without systemic symptoms. A 64-year-old woman was admitted with gross hematuria and azotemia. Laboratory findings revealed polyclonal gammopathy and severe anemia without definite cause, and she was diagnosed as C-ANCA positive crescentic glomerulonephritis without systemic vasculitis. She was treated with steroid pulse therapy and her renal function and anemia were progressively improved. We report herein a rare case of C-ANCA positive crescentic glomerulonephritis associated with polyclonal gammopathy and severe anemia with the review of literature.

A unique type of rapidly progressive interstitial fibrosis of the kidney, the Chinese Herb Nephropathy (CHN) has been reported in Belgian woman after intake of Chinese herbs. CHN contains several characteristics that include variable clinical features from progressive renal failure to Fanconi's syndrome, histologic finding of extensive interstitial fibrosis, high risk of urothelial malignancy. We are reporting a case of33 year-old female patient who was diagnosed as CHN. The patient visited our hospital with symptoms of nausea. Laboratory investigation showed metabolic acidosis with normal anion gap, hypokalemia, hypophosphatemia, proteinuria, glycosuria consistent with Fanconi's syndrome. She took Chinese herbs for slimming 4 months before. Renal biopsy showed the features of tubular cell injury with interstitial edema, accompanied by interstitial fibrosis on following biopsy, compatible with Chinese Herb Nephropathy. After 5 months, her renal function was progressed rapidly, therefore peritoneal dialysis was started. This case shows that we should consider Chinese herb as a cause of renal failure.

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• Update of aristolochic acid nephropathy in Korea
  Tae Hyun Ban, Ji-Won Min, Changhwan Seo, Da Rae Kim, Yu Ho Lee, Byung Ha Chung, Kyung-Hwan Jeong, Jae Wook Lee, Beom Seok Kim, Sang-Ho Lee, Bum Soon Choi, Jin Suk Han, Chul Woo Yang
  The Korean Journal of Internal Medicine.2018; 33(5): 961.     CrossRef