Abstract: TH-PO197

Primary Membranous Nephropathy and AKI

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Morris, Jessica D, Duke University, Durham, North Carolina, United States
  • Jafar, Tazeen H., Duke-NUS Graduate Medical School, Singapore, Singapore
Background


Over 90% of patients with primary membranous nephropathy present with preserved renal function with only 10-20% of patients progressing to ESRD. Here we present a case of respiratory failure and acute anuric renal failure requiring renal replacement therapy found to have primary membranous nephropathy.

Methods


Our patient was a 60 year old man with hypertension, baseline serum Cr of 0.7-0.9 mg/dl who presented to an outside hospital with fevers, cough, and shortness of breath. Two months prior he had presented to his primary care physician with lower extremity edema and was found to have 10 g of proteinuria on a24 hour urine collection. During evaluation at the outside hospital he was hypoxic requiring supplemental oxygen and serum Cr was 1.4 mg/dl. Chest imaging demonstrated bilateral infiltrates and pleural effusions. Within three days hypoxic respiratory failure progressed and he required BIPAP with increasing serum Cr to 3.0 mg/dl, he was subsequently transferred. On arrival to our hospital he was intubated within first 24 hours of presentation. He was anuric despite diuretics with increasing serum Cr to 4.0 mg/dl and was then started on dialysis. Given presentation of rapidly progressive pulmonary and renal failure, along with active urine sediment, methylprednisolone was started. Renal biopsy demonstrated findings consistent with membranous nephropathy and tubular injury. He was eventually extubated with negative influenza, bronchoscopy and blood cultures. Later, anti-PLA2R returned positive at 578 RU/mL and he was discharged on steroids. He continued to require dialysis at discharge. At follow up 2 months later renal function returned to baseline and dialysis was discontinued.

Conclusion


The AKI in this case was likely the combination of contrast, ARB therapy, NSAIDs, and hemodynamic insults in setting of hypoalbuminemia. This case highlights the importance of biopsy in determination of etiology of underlying diagnosis.