Abstract: PUB212
Peri-Infectious Glomerulonephritis (GN) Presenting as Minimal Change Disease
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Brand, Kenneth, UMass Chan Medical School- Baystate, Springfield, Massachusetts, United States
- Hodgins, Spencer, UMass Chan Medical School- Baystate, Springfield, Massachusetts, United States
- Crisi, Giovanna M., UMass Chan Medical School- Baystate, Springfield, Massachusetts, United States
- Hinckley, Ann, Kidney Care and Transplant Services of New England PC, West Springfield, Massachusetts, United States
- Madamas, Melissa M, Kidney Care and Transplant Services of New England PC, West Springfield, Massachusetts, United States
Introduction
Peri-Infectious GN (PIGN) is an immune complex–mediated lesion occurring after infection with bacteria, largely characterized by nephritic sydrome. We report a case of PIGN in a patient with a negative immunologic workup, bland urinalysis, & nephrotic range proteinuria to provide recommendations for practitioners to avoid missing this rare presentation
Case Description
We present a 78-year-old male with a baseline creatinine of 1.1 mg/dL who presented to the hospital with 2 weeks of bilateral lower extremity edema, a 20 pound weight gain, & a creatinine of 1.65 mg/dL later peaking at 2.84 mg/dL.
His echocardiogram was unremarkable. The man's serum albumin was 1.7 g/dL, & a random protein:creatinine ratio was 8.97.
His laboratory workup (ASO, C3, C4, hep B & C, PLA2R, anti-GBM, ANA, ANCA, Kappa: Lambda, SPEP, UPEP, & Immunofixation) was unremarkable. Due to his nephrotic syndrome & negative workup, a working diagnosis of adult-onset minimal change disease was made.
He was biopsied after 3 days of methylprednisolone & starting a steroid taper at 1mg/kg.
Light microscopy was non-specific & Immunofluorescence showed 1+ IgG/C3/K/L & focal c1q. Electron Microscopy (EM) showed electron-dense subepithelial deposits (Image 1). Further questioning revealed a hospital admission for community acquired pneumonia a week before his lower extremity edema began
Discussion
PIGN often presents as a nephritic syndrome with symptomatic cases frequently having sustained hypocomplementemia & elevated IgG & IgM. There is frequently a narrow differential diagnosis, covering C3 glomerulopathies including Dense Deposit Disease. However, a key characteristic of C3 GN is C3 staining intensity ≥ 2 orders of magnitude more than other immune reactants. Our patient’s immunofluorescent staining was 1+ for all reactants. Nephrotic syndrome is a rare presentation for PIGN & underscores the need for a thorough history, a broad differential, & EM on biopsy