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Kidney Week

Abstract: TH-PO973

Not So Stellar: IgA Nephropathy Secondary to Immunotherapy Treatment for Psoriasis

Session Information

Category: Trainee Case Report

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Davila- Marcano, Keyla Janice, Methodist Hospital Dallas, Dallas, Texas, United States
  • Gajanayaka, Ranil Sp, Dallas Nephrology Associates, Southlake, Texas, United States
  • Wickrama, Madappulli A.d.a.ganga, Baylor Scott and White Hospital, Richardson, Texas, United States
  • Collazo-Maldonado, Roberto L., Dallas Nephrology Associates, Southlake, Texas, United States
  • Sebastian, Lisa M., Dallas Nephrology Associates, Southlake, Texas, United States

Group or Team Name

  • Methodist Dallas Medical Center
Introduction

The increasing use of immunotherapy to treat inflammatory diseases and malignancy has resulted in an increase in glomerular injury reports. IgA deposition in the kidney has been associated with systemic conditions which include ulcerative colitis, seronegative spondyloarthropathies, dermatitis herpetiformis, CLD, and malignancies. These patients may show IgA deposits in the kidney mesangium, but IgA nephropathy is rarely diagnosed as patients do not always develop proteinuria or renal insufficiency. The discovery of IgA deposits in these patients is usually an incidental finding in autopsy. The incidence of glomerular disease in psoriasis is rare. We present this case of a patient with psoriatic arthritis that developed nephrotic syndrome with a kidney biopsy with IgA nephropathy after starting treatment with Ustekinumab.

Case Description


A 40 y/o Caucassian man with past medical history of psoriatic arthritis. He was treated with adalimumab,but became ineffective and it was changed to Ustekinumab. He had been receiving for 2 years at a dose of 45 mg every 2 weeks. After starting Ustekinumab, he developed nephrotic syndrome with proteinuria 6g/24h and worsening kidney function with a creatinine 1.6mg/dL (baseline creatinine 1.0 mg/dL). Physical examination remarkable for hypertension with BP 145/102 mmHg and bilateral leg edema+2. Serologic work up including ANA, ANCA, dsDNA, C3, C4, Hepatitis panel and cryoglobulinemia resulted negative. Kidney biopsy showed IgA nephropathy with mesangial hypercellularity. Ustekinumab was discontinued, and he was started on prednisone 60 mg PO daily and losartan 50 mg po daily. Kidney function has remained stable after 2 months of follow up with significant improvement in the proteinuria.

Discussion

Psoriasis has not typically been associated to glomerular disease. Immunotherapy agents have been mostly described to cause renal injury in the form of TMA, FSGS, ATN, AIN. Few cases have been reported of glomerular disease, particularly IgAN, in patients receiving Ustekinumab. In this case, the patient presented nephrotic syndrome only after receiving treatment with Ustekinumab. Nephrologists should be suspicious of the relationship of this agent and IgAN. It is important to diagnose early to ensure adequate treatment to minimize long term kidney complications.