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Kidney Week

Abstract: PO2219

Management of IgA Nephropathy and Concomitant Breast Cancer

Session Information

  • Onco-Nephrology - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
  • Shingarev, Roman A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction

Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide. Although treatment guidelines have been established, there is little known about the management of IgAN in the setting of solid malignancy. Herein we describe two cases of IgAN and breast cancer diagnosed at our center.

Case Description

Case 1: 42-year-old female with newly diagnosed breast cancer 3 months ago presents to the renal clinic for acute kidney injury (AKI) with creatinine (Cr) 3.5mg/dl from baseline 1.1-1.3mg/dl. Chemotherapy was started one week ago with doxorubicin and cyclophosphamide (ddAC). Two months prior to cancer diagnosis, her doctor noted 4.9g of protein in the urine with few RBCs. She now has 4g of protein with >50 RBCs. She underwent kidney biopsy which showed IgAN (M1 E1 S1 T2 C1). She received a 3g pulse of methylprednisolone (MP) followed by prednisone taper that was shortened to 3 months in light of degree of chronicity on biopsy and concurrent immunosuppressive ddAC treatment with 4 cycles total. Creatinine stabilized at 1.8mg/dL 9 months after last ddAC cycle and proteinuria improved to 1g after re-initiation of losartan.

Case 2: 38-year-old female presents to the renal clinic with AKI (Cr 1.8mg/dl from baseline 1.0mg/dl), gross hematuria and nephrotic range proteinuria that were detected incidentally in the emergency department, where she was seen for sore throat after the first 2 monthly ddAC cycles for the new diagnosis of breast cancer. She has a history of arthralgias associated with high citric citrullinated peptide, low myeloperoxidase titers and intermittent hematuria that led to a kidney biopsy demonstrating moderate focal global sclerosis without immune deposits or vasculitic lesions 4 years prior. Her symptoms improved on hydroxychloroquine which she stopped at the time of cancer diagnosis. Her kidney biopsy now shows IgAN (M1 E0 S1 T1 C2) for which she received a 1.6g pulse of MP followed by prednisone tapered over 5 months. She completed 3 cycles of ddAC. Creatinine improved to 0.9mg/dL and proteinuria receded from 7g to 0.5g.

Discussion

These cases highlight the complexity in management of IgAN while patients are undergoing treatment for a concurrent malignancy. Temporal relationship of IgAN and malignancy is unclear, but suggests potential value of cancer screening of patients with newly diagnosed IgA nephropathy.