Abstract: FR-PO178
Unusual Course of Paraneoplastic IgA Nephropathy Associated With Squamous Cell Lung Cancer
Session Information
- Onconephrology: Clinical and Research Advances - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Charkviani, Mariam, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Zhang, Pingchuan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Herrmann, Sandra, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction
Immunoglobulin A nephropathy (lgAN) is a common primary glomerulonephritis, that is characterized by glomerular IgA deposits, however paraneoplastic lgAN has been rarely reported. In this case report we describe an unusual clinical course of patient with squamous cell lung carcinoma that was subsequently diagnosed with lgAN/Henoch-Schönlein purpura (HSP)
Case Description
61-year-old male recently diagnosed with squamous cell carcinoma of the lung was referred for elevation of serum creatinine to 1.49 mg/dl from 0.9 mg/dl. He presented with vasculitic rash on lower extremities, and urinalysis showed acanthocytes and predicted 24-hour proteinuria of 7.8 g. Serologic and infectious workup so as monoclonal screen were negative. He underwent kidney biopsy that revealed diffuse mesangial and endocapillary hypercellularity with segmental fibrinoid necrosis and IgA dominant IF staining, consistent with crescentic IgAN/Henoch Schönlein purpura (HSP) nephritis (FIG 1). Immunosuppression was on hold due to active malignancy, and radiation and chemotherapy started. Follow up urinalysis showed less active sediment and decreased proteinuria. He also developed AKI thought to be pre-renal origin and improved with volume. But after cancer therapy changed to Durvalumab his creatinine peaked from 1.6 mg/dL to 2.84 mg/dl and urinalysis showed new sterile pyuria in addition of active sediment.There was concern for immune check point (ICI) induced acute interstitial nephritis (AIN) versus flare of IgA vasculitis. As patient presented with symptoms of ICI induced pneumonitis, Durvalumab was discontinued, and he was started on prednisone. His kidney function gradually improved while on steroids and after completing the course his creatinine was 1.68 mg/dl. Patient remained on remission under active surveillance by oncology for two years.
Discussion
Our case describes an unusual course of paraneoplastic IgA /HSP nephropathy and heightens the need for awareness of complications associated with these pathology and immunotherapy cancer agents.
Biopsy images: Light Microscopy and Immunofluorescent staining for IgA