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Abstract: PO1952

Pulmonary Renal Connection: A Case of ANCA Vasculitis and Atypical Anti-GBM Antibody Associated with Vaping

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Abraham, Josephine, University of Utah Hospital, Salt Lake City, Utah, United States
  • Al-Rabadi, Laith, University of Utah Hospital, Salt Lake City, Utah, United States
  • Revelo Penafiel, Monica Patricia, University of Utah Hospital, Salt Lake City, Utah, United States
  • Gregory, Martin C., University of Utah Hospital, Salt Lake City, Utah, United States

Group or Team Name

  • University Of Utah
Introduction

The use of e cigarettes and vaping is linked to the development of lung injury (EVALI). We present a case of ANCA (antinuclear cytoplasmic antibody) vasculitis with atypical Anti GBM (glomerular basement membrane) antibody in a patient with EVALI.

Case Description

A 17 year old male with a history of vaping presented with acute respiratory failure requiring mechanical ventilation. CT chest revealed diffuse bilateral consolidation. Evaluation for infection was negative. Nephrology was consulted for acute renal failure. Urine analysis was notable for hematuria and proteinuria. Urine microscopy identified dysmorphic erythrocytes. Renal biopsy showed pauci immune crescentic glomerulonephritis (panel A). ANCA with MPO (myeloperoxidase) specificity and Anti GBM antibody were positive. He was treated with methylprednisolone, therapeutic plasma exchange and oral cyclophosphamide initially and subsequently Rituximab. Four months later his creatinine was 1.2 mg/dL, improved from a peak level of 7.5mg/dL with negative ANCA and Anti GBM titers.
Two other patients with vaping associated lung injury admitted to the intensive care unit were noted to have dysmorphic hematuria. Urine microscopy in one was notable for red cell casts (panel B) and numerous string casts ( panel C).

Discussion

Anti GBM disease had been associated with alveolar injury from exposure to hydrocarbons or smoking. The presence of the erythrocyte casts and positive anti GBM antibody in patients with vaping associated lung injury raises the possibility of pulmonary and renal injury from a common mechanism. While the pathogenesis of vaping associated renal injury is unclear, examination of the urinary sediment should be performed in all patients presenting with vaping associated lung injury and hematuria.