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Kidney Week

Abstract: TH-PO683

An Unusual Case of ANCA Vasculitis Coexisting with Membranous Nephropathy due to Cocaine Use

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Flores Chang, Marjorie Mailing, SBH Health System, Bronx, New York, United States
  • Paredes, William Mauricio, SBH Health System, Bronx, New York, United States
  • Sarikhani, Hamed, SBH Health System, Bronx, New York, United States
  • Ibrahim, Jamil, SBH Health System, Bronx, New York, United States
  • Flores Chang, Bessy Suyin, SBH Health System, Bronx, New York, United States
Introduction

Membranous nephropathy (MN) is one of the leading entities causing nephrotic syndrome. Cocaine is associated with leukocytoclastic vasculitis, rhabdomyolysis, and ANCA-associated vasculitis (AAV) with pauci-immune necrotizing glomerulonephritis. We are reporting a rare case of a patient with rapidly progressive focal necrotizing & crescentic and sclerosing glomerulonephritis coexisting with MN in the setting of cocaine use.

Case Description

51 yo male with Heart Failure reduced EF 30%, ANCA-associated MPA with focal segmental pauciimmune glomerulonephritis, Rheumatoid arthritis, polysubstance use (cocaine, alcohol) presents with dyspnea and lower extremity edema. BP 149/110, HR 100 beats/min, RR 18 respirations/min, T 97.7 Fahrenheit, O2 96% on room air
Blood work showed macrocytic anemia of 8.1k with MCV 97.3, platelets: 256k, sodium: 139 mg/dL, potassium: 5.1 mg/dL, bicarbonate: 16, serum creatinine: 2.8 mg/dL, albumin: 1.9. BNP: 6992. UA >500 protein, moderate blood and RBCs 9, total protein creatinine ratio 3.88 g. Urine toxicology positive for cocaine and marihuana. C4 low 4, C3 low 68, ANA negative, RF negative, DsDNA: <1, P-ANCA 1:640, Myeloperoxidase ab elevated.
Patient was admitted due to HF exacerbation and started on intravenous furosemide. Kidney biopsy showed Membranous, focal necrotizing crescentic and sclerosing glomerulonephritis. Treatment with steroids and immunosuppressive therapy with Rituximab and cyclophosphamide which he completed and discharged home. Returned to the ED 2 weeks later with clinical signs of fluid overload, anemia, and worsening kidney function requiring blood transfusion and subsequently started on dialysis. Hospital course was complicated with sepsis due to pneumonia and 7.5 cm abscess-like fluid collection posterior the bladder, abdominal tap positive for resistant Enterococcus faecium and ESBL positive, cyclophosphamide was discontinued and started on IV broad spectrum antibiotics. Ultimately patient succumbed to the disease.

Discussion

Coexistence of ANCA vasculitis with MN due to cocaine use is not frequently reported in the literature, effect of cocaine in the kidney has multiple pathophysiological mechanisms, causing AKI but very few includes MN intention of this abstract is to make physicians aware of this for the future and warrant further investigation.