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Abstract: TH-PO710

A Novel Case of IgA Nephropathy Relapse Secondary to Adalimumab

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Naranjo, Christopher D., University of Miami School of Medicine, Miami, Florida, United States
  • Almeida, Margarita Dolores, University of Miami School of Medicine, Miami, Florida, United States
  • Sifain, Mary, University of Miami School of Medicine, Miami, Florida, United States
  • Valdes Sanchez, Chavely, University of Miami School of Medicine, Miami, Florida, United States
  • Kornblum, Zachary, University of Miami School of Medicine, Miami, Florida, United States
  • Ladino Avellaneda, Marco A., University of Miami School of Medicine, Miami, Florida, United States

Group or Team Name

  • University of Miami/Miami VAMC Fellowship Program.
Introduction

IgA nephropathy is the most diagnosed glomerulonephritis worldwide. Biologic agents including tumor necrosis factor alpha (TNFa) inhibitors have been identified as a potential cause for IgAN and on our patient, recurrence.

Case Description

The patient is a 35 year old male with biopsy proven IgA nephropathy diagnosed 4 years prior to current presentation. Initially, the patient was found to have microscopic hematuria and proteinuria on routine urinalysis. Kidney biopsy was performed at that time and demonstrated focal fibrocellular and fibrous crescentic disease. He was treated with glucocorticoid therapy and RAAS blockade, leading to full remission. He had underlying uveitis managed with Rituximab and Methotrexate, then Adalimumab.
On the current presentation, the patient reported an isolated episode of hematuria 2 months prior. Creatinine increased to 1.6 mg/dL from 1.1 mg/dL 4 months prior. A urinalysis demonstrated > 500 mg of albuminuria and 57 RBC/hpf. Spot urine protein to creatinine ratio was 526 mg/g.
A second kidney biopsy showed light microscopy demonstrated mesangial hypercellularity. Electron microscopy revealed patchy effacement of podocyte foot processes.

Discussion

We report a case of IgA nephropathy, which was initially treated with glucocorticoid therapy, leading to a sustained remission. Later, the patient was started on Adalimumab due to uveitis. IgAN relapsed after taking Adalimumab for 6 months.
On diagnosis, the patient was started on Mycophenolate Mofetil as a steroid sparing strategy. The patient deferred repeat treatment with glucocorticoid therapy. The patient was treated supportively with RAAS blockade and SGLT2i, with good anti-proteinuric response.
This is a novel case of recurrence of IgA nephropathy, as there is scant literature available that studies IgA Nephropathy related to Adalimumab. Furthermore, physicians must be aware of this potential side effect when prescribing Adalimumab, particularly in patients with underlying IgA nephropathy.