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Kidney Week

Abstract: TH-PO723

A Case of AKI Secondary to Toxocara-Induced C3 Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Huang, Kristine, Washington University in St Louis, St Louis, Missouri, United States
  • Ayoub, Malek, Washington University in St Louis, St Louis, Missouri, United States
  • Stockholm, Scott Christopher, Washington University in St Louis, St Louis, Missouri, United States
  • Kao, Patricia F., Washington University in St Louis, St Louis, Missouri, United States
Introduction

C3 glomerulonephritis (C3GN) is a rare form of glomerulonephritis that can occur secondary to infection. We present a case of biopsy-confirmed C3GN in a patient with AKI requiring dialysis and positive Toxocara IgG Ab who achieved partial remission with steroids.

Case Description

A 59-year-old male with hypertension and diabetes mellitus presented with a week of anasarca and oliguria after a 3-month trip to Cuba. Physical exam was notable for bilateral 4+ pitting edema up to his hips. Labs demonstrated a Cr of 16.81 mg/dL (1.16 mg/dL 16 months prior) and eosinophilia 1.9K/cumm. Urinalysis revealed 3+ protein, 21-50 WBC/hpf, >50 RBC/hpf, and a 24-hour urine protein of 5.4 grams. Notable serologic workup included elevated DNASE B Ab, ANA 1:160, and low serum C3. Hemodialysis (HD) was started for diuretic resistant oliguric AKI. His course was complicated by MRSA bacteremia necessitating a line holiday, during which time his urine output improved and his Cr and azotemia spontaneously stabilized without further HD. A kidney biopsy showed C3GN, 2/10 globally sclerotic glomeruli, moderate interstitial fibrosis, 40% tubular atrophy, and moderate hyaline arteriosclerosis. Initial infectious workup was negative. Given the biopsy results and persistence of Cr ~7 mg/dL, oral prednisone 60mg daily was initiated. ID recommended 2 days of empiric Ivermectin while awaiting results of a parasitic workup. His Cr steadily decreased to ~3 mg/dL on steroids. Toxocara IgG Ab subsequently resulted positive. There were no acute signs of Toxocariasis, so albendazole was not started. His Cr continued to improve at discharge.

Discussion

Toxocariasis, a parasitic helminth infection, can cause eosinophilia and is important to consider when evaluating for C3GN, even without active signs of infection. It is typically diagnosed with an ELISA Ab assay and treated with albendazole. Prednisone may be added for severe systemic involvement. Patients without active Toxocariasis, significant sclerosis, or fibrosis on renal biopsy may have good renal recovery after prompt steroid treatment.