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Abstract: PO1514

Postinfectious Glomerulonephritis Complicated by Complement-Positive Coombs Autoimmune Hemolytic Anemia

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Armstrong, Elizabeth Ann, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Hanna, Christian, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Fidler, Mary E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Tran, Cheryl L., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction

Postinfectious glomerulonephritis (PIGN) is the most common cause of GN in children. Mild normocytic anemia is often noted during the acute illness and is usually thought to be secondary to hemodilution from fluid overload and/or depressed erythrocytes production. Here, we describe a case of PIGN and autoimmune hemolytic anemia in a pediatric patient.

Case Description

A 3-year-old girl presented with 5 days of gross hematuria, fatigue, and decreased urination. Laboratory evaluation revealed elevated potassium at 5.4 mmol/L (normal range 3.6-5.2 mmol/L), creatinine 3.04 mg/dL (0.19-0.49 mg/dL), and blood urea nitrogen 98 mg/dL (7-20 mg/dL), low hemoglobin (Hb) 8.4 g/dL (11.4-14.3 g/dL) and normal platelet count. Urinalysis showed numerous red blood cells (RBCs) and nephrotic range proteinuria. Bilirubin, lactic dehydrogenase, and haptoglobin were normal. Direct antiglobulin test (DAT) was positive for monospecific C3, and negative for IgG. Peripheral blood smear revealed mild RBC polychromasia and occasional helmet cells. Several hours after admission, her Hb dropped acutely to 6.3 g/dL requiring blood transfusion. Complement proteins C3 and C4 were low at <6 mg/dL (75-175 mg/dL) and 5 mg/dL (14-40 mg/dL), respectively. DNase-B Antibody was normal and dsDNA antibody was negative. A kidney biopsy revealed findings consistent with PIGN (Image 1). She received acute hemodialysis for the first 48 hours after admission for worsening hyperkalemia, uremia, anuria, and edema. Her Hb remained stable and did not require additional blood transfusions.

Discussion

Our case of concurrent PIGN and autoimmune hemolytic anemia is exceptionally rare. This unique association may explain the anemia that is often seen in PIGN. We suggest that PIGN cases with anemia should have a DAT performed.