Abstract: PUB209
When Diabetes Blurs the Scene: A Case of Immunocomplex Glomerulopathy Secondary to Non-Hodgkin Lymphoma in a Patient with Diabetes
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Aldana Barrientos, Evelyn C., Southwest Healthcare Medical Education Consortium, Temecula, California, United States
- Sauceda, Oscar, Centro del Rinon diabetes y transplante renal, San Pedro Sula, San Pedro Sula, Honduras
Introduction
Immunocomplex glomerulopathy associated with Non-Hodgkin Lymphoma (NHL) is an uncommon diagnosis that can easily be missed when other pathologies like uncontrolled diabetes are present. In diabetic patients that undergo biopsy several studies have shown that more than 60% may have other causes of nephropathy associated. This case highlights how important it is to think beyond diabetes, especially in atypical presentations.
Case Description
67-year-old man with DM, HTN, and NHL in remission for two years after treatment with R-CHOP and rituximab. He was referred to nephrology for anemia and an elevated creatinine during routine follow-up with his PCP. Six months prior, his creatinine was 2.5 mg/dL; at presentation, it had increased to 6.2 mg/dL. Patient was asymptomatic. Labs with Hb 10.9 g/dL, 3.9 g/day of proteinuria, and A1c of 9.3%, with negative ANA, hepatitis B/C serologies, and normal complement levels. Kidney ultrasound revealed bilateral chronic changes. Despite his uncontrolled DM, the rapid decline in kidney function with nephrotic range proteinuria raised concern for a superimposed pathology, prompting a kidney biopsy. Biopsy showed membranoproliferative glomerulonephritis due to immunocomplex deposition. Immunofluorescence showed positivity for IgG, IgA, IgM, C1q, and C3c, with negative Congo red and C4c staining. Negative for Anti PLA2R in biopsy. Patient was diagnosed with immunocomplex glomerulopathy likely related to NHL. Patient was referred to oncology and started on empagliflozin, ARB, and better control of DM.
Discussion
This case is an example of how challenging it can be to reach the right diagnosis when more than one pathology is involved. Although diabetic nephropathy is common, not every diabetic with worsening kidney function fits in that category. When there are atypical features, like rapid progression, or a history of systemic disease such as NHL, it is crucial to consider a kidney biopsy. Biopsy remains a relatively safe procedure that can provide valuable information, help prevent misdiagnosis and potentially change the patient's management and outcome.