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Kidney Week

Abstract: PO1521

Renal Cell Carcinoma Presenting as Henoch-Schönlein Purpura with AKI and Leukocytoclastic Vasculitis in Adults

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Breithaupt, Ashton N., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Mettupalli, Neeharika, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Johnson, Stacy Alana, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Chedid, Alice, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
Introduction

Henoch-Schonlein purpura (HSP) is a small vessel vasculitis characterized by IgA tissue deposition. HSP presenting in adults is often the result of an underlying malignancy.

Case Description

A 60-year-old man with history of HTN, CVA, DMII, recent COVID-19 infection, presented for 2 week history of petechiae on bilateral upper and lower extremities. Skin biopsy findings were compatible with leukocytoclastic vasculitis (LCV). Patient on admission was also found to have AKI with creatinine 2.1 mg/dl, microscopic hematuria, and sub-nephrotic range proteinuria with urine protein/creatinine ratio of 2.66 g/g. Kidney biopsy findings were consistent with IgA dominant glomerulonephritis. Given multi-system involvement, patient was diagnosed with Henoch-Schonlein Purpura. Given unusual presentation with extreme of age, there was concern for malignancy. CT scan chest abdomen pelvis was performed which revealed a solid and septated 8.3 cm exophytic mass on the superior pole of left kidney. A partial left nephrectomy was performed with pathology report consistent with clear cell renal carcinoma. Patient’s hematuria, proteinuria and skin rash resolved with surgical intervention. Creatinine remained stable in the 1.6-1.8 mg/dl range on discharge.

Discussion

Henoch-Schonlein purpura (HSP) is generally seen in the first decade of life. There have been a few cases of HSP presenting in adults due to underlying solid organ malignancies including renal cell carcinoma (RCC). Our case illustrates the importance of evaluating adults presenting with clinical findings of HSP for underlying malignancy. Treatment of underlying malignancy will improve vasculitis symptoms including renal parameters.

Exophytic and sepatated mass within superior pole of left kidney (Figure 1).