{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T23:58:37Z","timestamp":1780963117477,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ther Apher Dial"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anti\u2010glomerular basement membrane (anti\u2010GBM) disease complicated by thrombotic microangiopathy (TMA) is rare and clinically challenging. In the setting of severe infection and active autoimmune disease, complement activation may reflect a secondary process rather than primary atypical hemolytic uremic syndrome (aHUS). Therapeutic plasma exchange (TPE) is standard therapy for anti\u2010GBM disease, but alternative antibody removal strategies are required when TPE is not tolerated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We describe a 46\u2010year\u2010old female with anti\u2010GBM disease who developed TMA with preserved ADAMTS13 activity (72.04%) and 2.3% schistocytes on peripheral smear. Soluble C5b\u20109 was elevated in the context of severe concurrent infection. TPE was discontinued due to intolerance (oxygen desaturation, fever, and dizziness). Seven sessions of protein A immunoadsorption (PAIA) were performed for selective antibody removal, and anti\u2010GBM antibody levels decreased from &gt;\u2009400 to 20.80 RU\/mL during treatment. Eculizumab was administered on Days 7, 14, and 30, for persistent complement activation. Hematologic and biochemical parameters stabilized and gradually improved during combined therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case suggests that PAIA may represent a feasible alternative antibody removal strategy in anti\u2010GBM disease intolerant to plasma exchange. In selected cases of secondary complement\u2010mediated TMA with ongoing complement activation, short\u2010term complement inhibition may contribute to disease stabilization; however, a definitive causal relationship cannot be established in a single case.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1744-9987.70172","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T23:04:28Z","timestamp":1780959868000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal Management of Anti\u2010\n                    <scp>GBM<\/scp>\n                    Disease Complicated by Secondary Complement\u2010Mediated Thrombotic Microangiopathy in a Patient Intolerant to Plasma Exchange: A Case Report"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4340-6469","authenticated-orcid":false,"given":"Xiangyu","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Nephrology Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Nephrology Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisha","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Nephrology Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4515-4682","authenticated-orcid":false,"given":"Shasha","family":"Chen","sequence":"additional","affiliation":[{"name":"Renal Department and Nephrology Institute Sichuan Provincial People's Hospital  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5664-7725","authenticated-orcid":false,"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China  Chengdu China"},{"name":"Renal Department and Nephrology Institute Sichuan Provincial People's Hospital  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"issue":"4","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1056\/NEJMoa0910500","article-title":"Molecular Architecture of the Goodpasture Autoantigen in Anti\u2010GBM Nephritis","volume":"363","author":"Pedchenko V.","year":"2010","journal-title":"New England Journal of Medicine"},{"issue":"4","key":"e_1_2_9_3_1","first-page":"755","article-title":"Goodpasture Syndrome and Anti\u2010Glomerular Basement Membrane Disease","volume":"41","author":"Reggiani F.","year":"2023","journal-title":"Clinical and Experimental Rheumatology"},{"issue":"2","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1159\/000367682","article-title":"Fibrinogen Reduction and Bleeding Complications in Plasma Exchange, Immunoadsorption, and a Combination of the Two","volume":"38","author":"Z\u00f6llner S.","year":"2014","journal-title":"Blood Purification"},{"issue":"1","key":"e_1_2_9_5_1","first-page":"i154","article-title":"Immunoadsorption in Anti\u2010GBM Disease: A Superior Alternative to Plasma Exchange?","volume":"28","author":"Biesenbach P.","year":"2013","journal-title":"Nephrology, Dialysis, Transplantation"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2023.1229806","article-title":"Unleashing the Power of Complement Activation: Unraveling Renal Damage in Human Anti\u2010Glomerular Basement Membrane Disease","volume":"14","author":"Tang A.","year":"2023","journal-title":"Frontiers in Immunology"},{"issue":"1","key":"e_1_2_9_7_1","first-page":"sfad298","article-title":"Complement Activation in Anti\u2010Glomerular Basement Membrane Disease Before and After Treatment","volume":"17","author":"Manivel V.","year":"2024","journal-title":"Clinical Kidney Journal"},{"issue":"7","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1056\/NEJMra1312353","article-title":"Syndromes of Thrombotic Microangiopathy","volume":"371","author":"George J. N.","year":"2014","journal-title":"New England Journal of Medicine"},{"issue":"17","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1056\/NEJMra0902814","article-title":"Atypical Hemolytic Uremic Syndrome","volume":"361","author":"Noris M.","year":"2009","journal-title":"New England Journal of Medicine"},{"issue":"12","key":"e_1_2_9_10_1","first-page":"983","article-title":"Complement Activation in Severe Sepsis","volume":"16","author":"Mache C. J.","year":"2001","journal-title":"Pediatric Nephrology"},{"issue":"6","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.ekir.2023.03.010","article-title":"Atypical Anti\u2010Glomerular Basement Membrane Disease","volume":"8","author":"Bharati J.","year":"2023","journal-title":"Kidney International Reports"},{"issue":"1","key":"e_1_2_9_12_1","article-title":"Efficacy of Protein A Immunoadsorption and Therapeutic Plasma Exchange in ANCA\u2010Associated Vasculitis With Severe Renal Involvement","volume":"56","author":"Wang L.","year":"2024","journal-title":"Annals of Medicine"},{"issue":"6","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1111\/trf.17865","article-title":"A Lower Fibrinogen Threshold Does Not Lead to Increased Bleeding Risk in Patients Receiving Therapeutic Plasma Exchange: A Prospective Single\u2010Center Analysis","volume":"64","author":"Wodajo A.","year":"2024","journal-title":"Transfusion"},{"issue":"11","key":"e_1_2_9_14_1","first-page":"3180","article-title":"Immunoadsorption and Plasma Exchange Are Comparable in Anti\u2010Neutrophil Cytoplasmic Antibodies or Anti\u2010Glomerular Basement Membrane Removal Kinetics","volume":"9","author":"Jourde\u2010Chiche N.","year":"2024","journal-title":"Kidney International Reports"},{"issue":"7","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s40262-019-00742-8","article-title":"Pharmacology, Pharmacokinetics and Pharmacodynamics of Eculizumab, and Possibilities for an Individualized Approach to Eculizumab","volume":"58","author":"Wijnsma K. L.","year":"2019","journal-title":"Clinical Pharmacokinetics"},{"issue":"1","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1159\/000371802","article-title":"A Case of Fibrillary Glomerulonephritis Associated With Thrombotic Microangiopathy and Anti\u2010Glomerular Basement Membrane Antibody","volume":"5","author":"Momose A.","year":"2015","journal-title":"Nephron Extra"},{"issue":"1","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s13730-016-0240-3","article-title":"A Case of PR3\u2013ANCA\u2010Positive Anti\u2010GBM Disease Associated With Intrarenal Arteritis and Thrombotic Microangiopathy","volume":"6","author":"Manabe S.","year":"2017","journal-title":"CEN Case Reports"},{"issue":"4","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s12026-017-8918-y","article-title":"Anti\u2010Glomerular Basement Membrane Glomerulonephritis With Thrombotic Microangiopathy: A Case Report","volume":"65","author":"Yu X. J.","year":"2017","journal-title":"Immunologic Research"},{"issue":"5","key":"e_1_2_9_19_1","first-page":"310","article-title":"Anti\u2010Glomerular Basement Membrane Disease With Thrombotic Thrombocytopenic Purpura","volume":"12","author":"Alirezaei A.","year":"2018","journal-title":"Iranian Journal of Kidney Diseases"},{"issue":"3","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","DOI":"10.34172\/jnp.2020.30","article-title":"Rapid Progressive Anti\u2010GBM Glomerulonephritis With Multiple Auto\u2010Antibodies","volume":"9","author":"Micarelli D.","year":"2020","journal-title":"Journal of Nephropathology"},{"issue":"1","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4103\/1319-2442.318529","article-title":"Anti\u2010Glomerular Basement Membrane Disease With Atypical Associations","volume":"32","author":"Malviya P.","year":"2021","journal-title":"Saudi Journal of Kidney Diseases and Transplantation"},{"issue":"14","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.2169\/internalmedicine.4943-20","article-title":"Anti\u2010Glomerular Basement Membrane Disease With Antiphospholipid Syndrome","volume":"60","author":"Torigoe M.","year":"2021","journal-title":"Internal Medicine"},{"key":"e_1_2_9_23_1","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/2676696","article-title":"A Case of Paediatric Anti\u2010Glomerular Basement Membrane Disease Associated With Thrombotic Thrombocytopenic Purpura","volume":"2022","author":"McAllister J.","year":"2022","journal-title":"Case Reports in Nephrology"},{"issue":"3","key":"e_1_2_9_24_1","first-page":"328","article-title":"Clinical Characteristics of Anti\u2010GBM Disease With Thrombotic Microangiopathy: A Case Report and Literature Review","volume":"12","author":"Nakamura Y.","year":"2023","journal-title":"CEN Case Reports"},{"issue":"7","key":"e_1_2_9_25_1","article-title":"Complement\u2010Mediated Thrombotic Microangiopathy in a Patient With Antiphospholipid Syndrome and Anti\u2010Glomerular Basement Membrane Antibodies","volume":"15","author":"Gallant T. L.","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_9_26_1","doi-asserted-by":"crossref","DOI":"10.1177\/23247096231184760","article-title":"Seronegative Atypical Anti\u2010Glomerular Basement Membrane Glomerulonephritis Associated With Thrombotic Microangiopathy: Case Report and Literature Analysis","volume":"11","author":"Roy S.","year":"2023","journal-title":"Journal of Investigative Medicine High Impact Case Reports"},{"issue":"5","key":"e_1_2_9_27_1","first-page":"1378","article-title":"Complement\u2010Mediated Thrombotic Microangiopathy in Autoimmune Diseases","volume":"11","author":"Carvouli A.","year":"2023","journal-title":"Biomedicine"}],"container-title":["Therapeutic Apheresis and Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70172","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1744-9987.70172","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T23:04:33Z","timestamp":1780959873000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1744-9987.70172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":26,"alternative-id":["10.1002\/1744-9987.70172"],"URL":"https:\/\/doi.org\/10.1002\/1744-9987.70172","archive":["Portico"],"relation":{},"ISSN":["1744-9979","1744-9987"],"issn-type":[{"value":"1744-9979","type":"print"},{"value":"1744-9987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"assertion":[{"value":"2026-01-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1744-9987.70172"}}