Abstract: FR-PO731

Lupus-Like Glomerular Immune Complex Deposits in a Subset of Patients with Liver Cirrhosis – Histologic Features and Clinical Correlates

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Satoskar, Anjali A., Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Hemminger, Jessica, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Arole, Vidya, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Ayoub, Isabelle, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Nadasdy, Tibor, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Background

Glomerular IgA deposits have been previously reported in patients with liver cirrhosis as incidental findings, mainly in autopsy studies. We recently encountered patients with liver cirrhosis presenting with acute kidney injury and large lupus-like glomerular immune deposits. None had systemic lupus erythematosus. Our aim was to systematically elucidate their clinical and biopsy features, and treatment outcomes.

Methods

We searched our kidney biopsy database over a 13-year period, from January 2004 to December 2016 for all native kidney biopsies from patients with cirrhosis.

Results

We found 118 kidney biopsies from cirrhotic patients, 76/118 had glomerular IgA staining. Nine of these 76 had large IgA, IgG and C3 containing glomerular immune complex deposits (Fig 1) and proliferative glomerulonephritis. Six of 9 patients had concomitant acute bacterial infection, prompting a biopsy diagnosis of infection-associated glomerulonephritis and treatment with antibiotics. In the remaining 3/9 patients, infectious workup was negative and were administered steroids. Overall clinical outcomes were poor among the 9 patients, but 2/6 patients treated with antibiotics (1 with liver transplant), and 1/ 3 patients on steroids recovered renal function.

Conclusion

These cases provide support to the theory that advanced liver failure can compromise the ability to clear circulating immune complexes, contributing to the build-up of large immune complex deposits in the kidney and concomitant bacterial infection probably provides a “second-hit” triggering acute glomerulonephritis in at least a subset of these patients. A trial of antibiotics is recommended and caution is advised before administering immunosuppressive treatment. Bacterial infection can be subtle and difficult to diagnose. However, both diagnosis and management of glomerulonephritis in these patients remains a challenge.

Fig.1