Abstract: SA-PO363
Syphilis-Associated Idiopathic Nodular Glomerulosclerosis
Session Information
- Genetic and Diagnostic Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Chandrasekhar, Sanjay A., University of South Florida , Winter Haven, Florida, United States
- Gupta, Sumit, University of South Florida , Winter Haven, Florida, United States
- Chavez, Octavio, University of South Florida , Winter Haven, Florida, United States
- Doumit, Elias, University of South Florida , Winter Haven, Florida, United States
- Bassil, Claude, University of South Florida , Winter Haven, Florida, United States
Introduction
Idiopathic nodular glomerulosclerosis (ING) is a rare entity in non-diabetics with a similar appearance on biopsy to diabetic nephropathy. ING has been associated with hypertension, dyslipidemia, and cigarette smoking; however, there is no known association with syphilis. Here we present a case of possible latent syphilis associated ING.
Case Description
A 73-year-old non-diabetic male with history of urothelial carcinoma, chronic kidney disease stage III, and mild hypertension presented due to worsening lower extremity swelling. Initial creatinine was elevated at 2.2 mg/dL. Urinalysis was notable for large blood and protein. Workup revealed urine protein of 6939 mg. Serologic workup was negative including C3, C4, ANA, dsDNA, ANCA, Hep B/C, and monoclonal antibodies. Of note, rapid plasma reagin and fluorescent treponemal antibody were positive. The patient was without signs of syphilis with a diagnosis of latent syphilis made. Light microscopy noted interstitial fibrosis, tubular atrophy, and globally sclerotic glomeruli. Immunofluorescence staining highlighted linear IgG accentuation. Electron microscopy revealed foot process effacement, increased mesangial matrix, and swollen endothelial cells. He was diuresed and discharged with continued follow-up in clinic with control of symptoms.
Discussion
ING presents in non-diabetics likely due to the formation of advanced glycation end products, angiogenesis, and altered renal hemodynamics. ING has an association with cigarette smoking, hypertension, dyslipidemia, and obesity. Our patient did not have a history of diabetes or smoking and was found to have markers positive for syphilis. Manifestations of syphilitic renal disease include but are not limited to membranous glomerulonephritis, focal segmental glomerulosclerosis, minimal change disease, and interstitial nephritis. However, a review of the literature has not shown a case of syphilis associated ING.
ING is most commonly seen with cigarette smoking with concurrent hypertension. However, other pathophysiologic factors cannot be excluded. Given the new diagnosis of syphilis, syphilitic involvement must be considered as an etiology in conjunction with underlying mild hypertension given lack of diabetes history. While it cannot be shown that syphilis is responsible, clinical awareness of the possibility may allow for further identification of cases in the future.