Double Insult: Secondary IgA and Anticoagulant-Related Nephropathy
- Glomerular Diseases: From Inflammation to Fibrosis - II
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1401 Glomerular Diseases: From Inflammation to Fibrosis
- Pabon-Vazquez, Elizabeth, Augusta University Medical College of Georgia, Augusta, Georgia, United States
- Thomas, George N., Augusta University Medical College of Georgia, Augusta, Georgia, United States
- Anea, Bogdan, Augusta University Medical College of Georgia, Augusta, Georgia, United States
- Kosuru, Vatsalya, Augusta University Medical College of Georgia, Augusta, Georgia, United States
Acute kidney injury represents the most frequent nephrology consultation. In select cases,AKI is the result of series of cumulating insults overlapping previously undiagnosed conditions.These usually carry a significant negative impact towards renal recovery.
This is the case of a 62-year-old male with a past medical history of peripheral artery disease,s/p right below the knee amputation,severe ischemic cardiomyopathy s/p intra-cardiac device,atrial fibrillation on apixaban,diabetes mellitus and hypertension,who was admitted for cellulitis in the amputated stump.In addition to cellulitis,the patient reported a non-blanching petechial rash on the left arm which was present for several months.Hospitalization was complicated by AKI;and initial workup revealed a history of daily NSAID use and elevated vancomycin levels with granular casts noted on urine microscopy.An initial diagnosis on acute tubular necrosis due to intrinsic etiology was suspected.However,renal function continued to worsen,and given the patient's rash,we suspected for acute interstitial nephritis or vasculitis.Skin biopsy revealed leukocytoclastic vasculitis that was negative for IgA deposition.Further immunologic workup was negative.No peripheral eosinophilia was observed,and blood cultures were positive for Staphylococcus Aureus.A renal biopsy was performed,which showed IgA-dominant immune complex deposition,likely secondary to infection,and numerous cortical and medullary RBC casts out of proportion to the degree of glomerular injury,concern for anticoagulant associated nephropathy.Moderate interstitial fibrosis and tubular atrophy with no crescents was described.Due to active infection,steroids were not recommended,and the patient’s anticoagulation was placed on hold.Unfortunately,due to significant renal injury the patient was initiated on hemodialysis and subsequently,did not show signs of renal recovery.
Our patient has dialysis-dependent AKI complicated by secondary IgA nephropathy associated with infection along with anticoagulant-associated nephropathy,related to eliquis.Comorbidities such as diabetes,hypertension,and advanced age can negatively impact the response to therapy.In our case,the patient was also diagnosed with anticoagulant-associated nephropathy which further decreased his chances of recovery.