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Kidney Week

Abstract: PO1639

Remission of IgA Nephropathy with Hydroxychloroquine

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Tariq, Hafsa, University Hospitals, Cleveland, Ohio, United States
  • Dhingra, Jagmeet S., MetroHealth Medical Center, Cleveland, Ohio, United States
Introduction

IgA nephropathy is the most common form of glomerulonephritis in the world. Treatment options include blockade of renin-angiotensin-system (RAS) as the first line of therapy. Steroids may be beneficial in refractory cases, however, can result in several adverse effects. Data regarding use of immunosuppression is inconclusive. Combination of RAS inhibition and hydroxychloroquine has shown to reduce proteinuria in recent studies, though, complete remission with long term use has not been described. We report the case of a 46-year-old Asian female with IgA nephropathy, who was treated with maximally tolerated RAS inhibition and hydroxychloroquine for about 24- months resulting in complete remission of proteinuria and hematuria.

Case Description

The patient was referred to nephrology for evaluation of hematuria and proteinuria (1.5g/g, Serum creatinine 0.9mg/dl). Serological work-up was negative. She was initiated on angiotensin receptor blocker (ARB) and underwent kidney biopsy which confirmed IgA Nephropathy. There were 8 glomeruli with 20-25% sclerosis, mild to moderate chronic tubulointerstitial nephritis and fibrosis, no crescents, mild mesangial proliferation and hypercellularity with IgA staining 3+. She did not have any significant improvement in proteinuria despite maximally tolerated ARB (losartan 100 mg daily) therapy for three months. Her kidney function also declined, creatinine 1.2mg/dl. Hydroxychloroquine 200mg daily was then initiated along with regular eye exams and hepatic function tests. Repeat workup in three months showed improvement in proteinuria to 0.2g/g and creatinine 1.1mg/dl. She was continued on the same regimen for about 24- months, with recent work-up showing complete resolution of proteinuria and hematuria.

Discussion

As per our literature review, this is the first reported case of IgA nephropathy treated with RAS inhibition and hydroxychloroquine over a span of almost two years resulting in complete remission. Hydroxychloroquine can be considered, in select cases, as an alternative to steroid therapy in refractory proteinuria.

Trend of serum creatinine and spot proteinuria measurement