Abstract: PUB288
A Case of Dialysis-Dependent Rapidly Progressing C3 Glomerulonephritis
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Hirpara, Samir, Inova Fairfax Hospital, Falls Church, Virginia, United States
- Hedden, Morgan, Inova Fairfax Hospital, Falls Church, Virginia, United States
- Nguyen, Alison, Inova Fairfax Hospital, Falls Church, Virginia, United States
- Regunathan-Shenk, Renu, Virginia Nephrology Group, Fairfax, Virginia, United States
- Modlinger, Paul S., Virginia Nephrology Group, Fairfax, Virginia, United States
Introduction
We present a case of dialysis-dependent rapidly progressing C3 glomerulonephritis (GN) without evidence of infection or paraproteinemia.
Case Description
Our patient (pt) is a 72-year-old male who presented with a subacute history of weight loss, fatigue, bilateral flank pain, and anasarca. Given his non-specific presentation, he initially went to an oncologist. Workup including bone marrow biopsy and serum protein electrophoresis was unremarkable aside from a creatinine elevation from a baseline of 0.8 (1 month prior) to 7.4 mg/dL. After admission to the hospital, he initiated hemodialysis for acute kidney injury. Autoimmune evaluation revealed negative anti-nuclear cytoplasmic antibody (ANCA), negative double-stranded DNA, low complement C3 (25 mg/dL), normal complement C4 (17 mg/dL), and anti-nuclear antibody testing (ANA) was weakly positive (1:160, speckled appearance). Repeat serum protein electrophoresis with immunofixation was negative. Infectious evaluation including urine culture, blood cultures, and a transthoracic echocardiogram was also negative. Renal biopsy revealed crescentic C3 GN. He was started on prednisone with plans to initiate cyclophosphamide pending insurance clearance. However, within 4 weeks, the pt recovered off of dialysis prior to the initiation of cyclophosphamide. The patient has continued on a steroid taper and was initiated on mycophenolate mofetil 1,500 mg twice daily. His most recent metabolic panel showed a creatinine of 0.78 mg/dL and persistent microscopic hematuria at approximately 5 months since diagnosis.
Discussion
To our knowledge, this is the first reported case of dialysis-dependent C3 GN which improved with steroid treatment alone. It remains unclear if the patient experienced post-infectious GN from an unidentified infection versus an idiopathic C3 GN with rapid progression.