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Kidney Week

Abstract: TH-PO886

Luetic Nephropathy: An Underrecognized Etiology of Nephropathy

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Khan, Umair, Newark Beth Israel Medical Center, Newark, New Jersey, United States
  • Thimmareddygari, Divya Mounisha Reddy, Newark Beth Israel Medical Center, Newark, New Jersey, United States
  • Warraich, Fatima Z., Baystate Medical Center, Springfield, Massachusetts, United States
  • Murari, Ujjwala, Newark Beth Israel Medical Center, Newark, New Jersey, United States
  • Lefkowitz, Heather Rush, Newark Beth Israel Medical Center, Newark, New Jersey, United States
Introduction

Syphilis is an underrecognized cause of nephropathy. Most cases of syphilis are diagnosed in individuals with HIV, Hepatitis B and/or C and hence nephropathy may wrongly be attributed to them. Here we present an unusual case of luetic nephropathy presenting as crescentic glomerulonephritis.

Case Description

A 80-year-old female with a history of hypertension and Parkinson’s disease was evaluated for lower extremity swelling, facial edema, and elevated serum creatinine. Workup revealed creatinine of 1.5 mg/dL (baseline of 1.01 mg/dL), proteinuria with a urine protein-creatinine ratio of 507 mg/g, mild hematuria without any casts or sediments. Serological panel was positive for antiproteinase 3 (PR-3-ANCA) however was negative for cytoplasmic (C-ANCA), perinuclear (P-ANCA), HIV, HBV, HCV, with normal complements (C3/C4). Lupus, scleroderma, GBM, Sjogren’s, Group A strep and primary membranous nephropathy workup was negative. Drug-associated glomerulonephritis was excluded clinically. Infectious work-up revealed a Rapid Plasma Reagin level of 1:1 and positive Treponemal antibody. A diagnostic kidney biopsy showed fibrous crescents consistent with crescentic glomerulonephritis and chronic interstitial inflammation with eosinophils without features of necrotizing arteritis. In our case, biopsy findings of crescentic glomerulonephritis with positive syphilis serologies highly suggested luetic nephropathy and hence was then started on penicillin therapy.

Discussion

Syphilis-associated renal disease (luetic nephropathy), is an uncommon disease with a wide variety of manifestations. It presents as a nephrotic syndrome with varying degrees of proteinuria [1,2]. It is now known that deposition of IgG against treponema pallidum in the renal mesangium incites the onset of nephropathy [2]. Walker et al reported a case of secondary syphilis associated with crescentic glomerulonephritis [3]. Syphilis-associated glomerulonephritis is part of the infection-related glomerulonephritis whose main treatment is infection resolution. The implementation of steroid in such cases is unclear but may aid in reducing irreversible glomerular scarring. KDIGO guidelines do not advice to screen for syphilis however given its increased prevalence, luetic nephropathy should be kept in mind to while evaluating patients with renal dysfunction.