<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0026-1742</journal-id>
<journal-title><![CDATA[Revista de la Facultad de Medicina (México)]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Fac. Med. (Méx.)]]></abbrev-journal-title>
<issn>0026-1742</issn>
<publisher>
<publisher-name><![CDATA[Universidad Nacional Autónoma de México, Facultad de Medicina]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0026-17422025000400038</article-id>
<article-id pub-id-type="doi">10.22201/fm.24484865e.2025.68.4.05</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Granulomatosis con poliangeítis asociada a síndrome nefrótico, insuficiencia renal y dificultad respiratoria rápidamente progresivos. Informe de un caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Granulomatosis With Polyangiitis Associated with Nephrotic Syndrome, Rapidly Progressive Renal Failure, and Respiratory Distress: A Case Report]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Espinoza-Gomez]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Garcia Cardenas]]></surname>
<given-names><![CDATA[Angel Ivan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Garibay Montoy]]></surname>
<given-names><![CDATA[Rubén]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nava-Zavala]]></surname>
<given-names><![CDATA[Arnulfo Hernán]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Colima  ]]></institution>
<addr-line><![CDATA[ Colima]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Autónoma de Guadalajara  ]]></institution>
<addr-line><![CDATA[Jalisco Guadalajara]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<volume>68</volume>
<numero>4</numero>
<fpage>38</fpage>
<lpage>43</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0026-17422025000400038&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0026-17422025000400038&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0026-17422025000400038&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen La granulomatosis con poliangeítis (GPA) es una vasculitis asociada a anticuerpos anticitoplasma de neutrófilos (ANCA), siendo el antígeno principal la proteinasa-3 (cANCA-PR3). La GPA afecta vasos de mediano y pequeño calibre del tracto respiratorio y de los riñones, provocando glomerulonefritis y neumonitis de grado variable. La presencia de síndrome nefrótico (SN) y de síndrome de dificultad respiratoria aguda (SDRA) asociados a GPA es muy infrecuente y representa un reto clínico en cuanto a su diagnóstico y manejo oportuno. Se presenta el caso de una paciente con diabetes mellitus tipo 2 (DM2), quien desarrolló un SN con hematuria y lesión renal rápidamente progresiva, acompañados de SDRA y nódulos pulmonares. A pesar del tratamiento con hemodiálisis, ventilación mecánica asistida y metilprednisolona intravenosa, el curso fue fatal tras 3 semanas de evolución. La positividad para cANCA-PR3 complementó el diagnóstico de GPA. El desarrollo de SN con hematuria y LR rápidamente progresiva en pacientes con DM, debe alertar sobre la posibilidad diagnóstica de vasculitis, como la GPA. Por su parte, la aparición de SDRA en pacientes con neumopatía secundaria a GPA también es muy inusual. Por ello, la combinación de GPA, DM2, SN con LRRP y SDRA representa un importante reto diagnóstico y terapéutico, que debe ser considerado en el abordaje de pacientes diabéticos con nefropatía atípica.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Granulomatosis with polyangiitis (GPA) is a type of vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA), with the main antigen being proteinase-3 (cANCA-PR3). GPA affects small- and medium-sized vessels of the respiratory tract and kidneys, leading to varying degrees of glomerulonephritis and pneumonitis. The occurrence of nephrotic syndrome (NS) and acute respiratory distress syndrome (ARDS) in association with GPA is extremely rare and poses a diagnostic and therapeutic challenge. We report the case of a patient with type 2 diabetes mellitus (DM2) who developed NS with hematuria and rapidly progressive renal injury, along with ARDS and pulmonary nodules. Despite treatment with hemodialysis, mechanical ventilation, and intravenous methylprednisolone, the clinical course was fatal after three weeks. A positive cANCA-PR3 result confirmed the diagnosis of GPA. The development of NS with hematuria and rapidly progressive renal failure in patients with diabetes should raise suspicion for vasculitis, such as GPA. Similarly, the onset of ARDS in patients with GPA-related lung disease is highly unusual. Therefore, the combination of GPA, DM2, NS with rapidly progressive renal injury, and ARDS represents a major diagnostic and therapeutic challenge that should be considered when managing diabetic patients with atypical nephropathy.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Granulomatosis con poliangeítis]]></kwd>
<kwd lng="es"><![CDATA[síndrome nefrótico]]></kwd>
<kwd lng="es"><![CDATA[dificultad respiratoria aguda (SRA)]]></kwd>
<kwd lng="en"><![CDATA[Granulomatosis with polyangiitis]]></kwd>
<kwd lng="en"><![CDATA[nephrotic syndrome]]></kwd>
<kwd lng="en"><![CDATA[acute respiratory syndrome (ARS)]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sang-Won]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Yong-Beom]]></surname>
<given-names><![CDATA[P.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Classification of antineutrophil cytoplasmic antibody-associated vasculitis]]></article-title>
<source><![CDATA[J Rheum Dis]]></source>
<year>2019</year>
<volume>26</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>156-64</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Robson]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Grayson]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
<name>
<surname><![CDATA[Ponte]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Suppiah]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Craven]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Judge]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[2022 American College of Rheumatology/European Alliance of Associations for Rheumatology. Classi&#64257;cation criteria for granulomatosis with polyangiitis]]></article-title>
<source><![CDATA[Arth Rheumatol]]></source>
<year>2022</year>
<volume>74</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>393-9</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[FG]]></given-names>
</name>
<name>
<surname><![CDATA[Iqbal]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Irfan]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Etiology and outcome of pulmonary renal syndrome: Retrospective study from a tertiary care hospital]]></article-title>
<source><![CDATA[J Pak Med Assoc]]></source>
<year>2019</year>
<volume>69</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>588-91</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aasarød]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Bostad]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Hammerstrøm]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Jørstad]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Iversen]]></surname>
<given-names><![CDATA[BM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Renal histopathology and clinical course in 94 patients with Wegener&#8217;s granulomatosis]]></article-title>
<source><![CDATA[Nephrol Dial Transp]]></source>
<year>2001</year>
<volume>16</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>953-60</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Novikov]]></surname>
<given-names><![CDATA[PI]]></given-names>
</name>
<name>
<surname><![CDATA[Moiseev]]></surname>
<given-names><![CDATA[SV]]></given-names>
</name>
<name>
<surname><![CDATA[Kuznetsova]]></surname>
<given-names><![CDATA[EI]]></given-names>
</name>
<name>
<surname><![CDATA[Semenkova]]></surname>
<given-names><![CDATA[EN]]></given-names>
</name>
<name>
<surname><![CDATA[Mukhin]]></surname>
<given-names><![CDATA[NA.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Changing patterns of clinical severity and risk of mortality in granulomatosis with polyangiitis over four decades: the Russian experience]]></article-title>
<source><![CDATA[Rheumatol Int]]></source>
<year>2015</year>
<volume>35</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>891-8</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nishino]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Minami]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Uramatsu]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Obata]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Arai]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Sakamoto]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[An elderly patient with diabetic nephropathy complicated by ANCA-associated nephritis]]></article-title>
<source><![CDATA[Intern Med]]></source>
<year>2012</year>
<volume>51</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>1227-32</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gómez-Gómez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez-Martínez]]></surname>
<given-names><![CDATA[MU]]></given-names>
</name>
<name>
<surname><![CDATA[Cuevas-Orta]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Bernal-Blanco]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Cervantes-Ramírez]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez-Martínez]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pulmonary manifestations of granulomatosis with polyangiitis]]></article-title>
<source><![CDATA[Reumatol Clin]]></source>
<year>2014</year>
<volume>10</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>288-93</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pereira]]></surname>
<given-names><![CDATA[CV]]></given-names>
</name>
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Nogueira]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Marques]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Pereira]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Dias]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Granulomatosis with polyangiitis: An atypical initial presentation]]></article-title>
<source><![CDATA[J Transl Autoimmun]]></source>
<year>2022</year>
<volume>5</volume>
<page-range>100149</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nasr]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Balasubramanian]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Desiderio]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Abdelattif]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A rare case of nephrotic-range proteinuria in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis]]></article-title>
<source><![CDATA[Cureus]]></source>
<year>2022</year>
<volume>14</volume>
<numero>6</numero>
<issue>6</issue>
</nlm-citation>
</ref>
<ref id="B10">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Gao]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Hu]]></surname>
<given-names><![CDATA[SY]]></given-names>
</name>
<name>
<surname><![CDATA[Wei]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Yan]]></surname>
<given-names><![CDATA[TK.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical and pathologic characteristics of pauci-immune antimyeloperoxidase antibody-associated glomerulonephritis with nephrotic range proteinuria]]></article-title>
<source><![CDATA[Ren Fail]]></source>
<year>2018</year>
<volume>40</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>554-60</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Almaani]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Fussner]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
<name>
<surname><![CDATA[Brodsky]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Meara]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Jayne]]></surname>
<given-names><![CDATA[D.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[ANCA-associated vasculitis: an update]]></article-title>
<source><![CDATA[J Clin Med]]></source>
<year>2021</year>
<volume>10</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>1446</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
