Abstract: TH-PO631

New-Onset Crescentic Glomerulonephritis Following Preeclampsia: A Diagnostic Dilemma

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Soliman, Karim Magdy Mohamed, Medical University of South Carolina, Charleston, United States
  • Mohialdeen, Mohammed Zuhair, Medical University of South Carolina, Charleston, South Carolina, United States
  • Ploth, David W., Medical University of South Carolina, Charleston, South Carolina, United States
Background

New-onset crescentic Glomerulonephritis (GN) in the postpartum period following preeclampsia with normal GFR after delivery has not been reported. AKI 2 days post CT with contrast complicates making this diagnosis.

Methods

A 28 year old female G3P2 with no significant past medical history presented during her 36th week of pregnancy with preeclampsia and urine protein excretion of 4 gm/24hr. C-section delivered a viable fetus. She was discharged with serum creatinine (Cr) 0.8 mg/dl. She returned with fatigue and abdominal tenderness 2 weeks later. CT imaging with contrast revealed a supra-uterine hematoma prompting surgical evacuation. Two days later she developed progressive increase in lower extremity edema, puffiness of eyelids, oliguria and microscopic hematuria. Hemoglobin was 7.6 gm/dl, platelets 220 K/cmm, Cr 9.2 mg/dl, albumin 1.8 gm/dL and urine protein excretion 8.8 gm/24hr (clinical course in Fig.1). Viral markers (Hepatitis B, C and HIV), C3, C4 and immune profile, were all negative. Renal biopsy revealed twenty glomeruli, all showed cellular crescents (arrows in Fig.2) and collapsing of capillary loops with moderate endocapillary proliferation. Immunoperoxidase staining was negative for IgA, IgG with weak focal positive staining for IgM within the crescents.

Conclusion

The patient did not require dialysis and renal functions responded favourably to plasma exchange, steroids and cyclophosphamide. Three months later Cr was 2 mg/dl and urine protein 4 gm/24 hr. At this time, further therapy options are being discussed. Educational objectives include; always confirm the clinical suspicion of glomerular disease with biopsy whenever possible. Hidden triggering elements for crescentic GN merit consideration.