Abstract: TH-PO096

Immunoglobulin A-Dominant Glomerulopathy and Thrombotic Microangiopathy after Chemotherapy: A Report of Three Cases

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Dvanajscak, Zeljko, University of California San Diego, San Diego, California, United States
  • Karl, Bethany E., UCSD Health, San Diego, California, United States
  • Walavalkar, Vighnesh, University of California San Diego, San Diego, California, United States
Background

Chemotherapeutic agents are a well-known cause of renal dysfunction and are known to cause injury to all compartments of the kidney. Amongst the glomerular diseases, immune complex mediated glomerulonephritis (usually IgG-dominant) and thrombotic microangiopathy (TMA) are the most commonly reported patterns of injury. We have recently encountered three unusual cases of IgA-dominant glomerulonephritis with superimposed TMA occurring after chemotherapy.

Methods

All three had an unusual pattern of IgA dominant immune complex deposition, not entirely compatible with known IgA-dominant immune complex mediated glomerulopathies like IgA nephropathy or IgA-dominant infection associated glomerulonephritis. All three cases had superimposed TMA. The patients were closely followed prior to and after renal biopsy. In each case there was no suggestion of pre-existing renal disease prior to initiation of chemotherapy; and presenting symptomology leading to biopsy occurred after initiation of the drug, suggesting contemporaneous relationship/association to the drug. All patients were successfully treated by cessation of the drug and steroid therapy. Several months of follow-up shows stable renal function without proteinuria or active urinary sediment in both patients.

Conclusion

We present these cases to discuss the differential diagnosis, approach to biopsy, potential mechanisms of injury, treatment considerations and to spread awareness of this unique pattern of renal injury seen after chemotherapy.