Abstract: SA-PO0906
Double Trouble: A Diagnostic Dilemma in Coexisting IgAN and Postinfectious Glomerulonephritis
Session Information
- Glomerular Case Reports: ANCA, IgA, IgG, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Patra, Tumpa, Crestwood Medical Center, Huntsville, Alabama, United States
- Bag, Soumyadeep, The University of Alabama at Birmingham School of Medicine Huntsville, Huntsville, Alabama, United States
- Christmas, Troye, Crestwood Medical Center, Huntsville, Alabama, United States
- Uma Dwarakanath, Namitha, Crestwood Medical Center, Huntsville, Alabama, United States
- Poojary, Indira, Crestwood Medical Center, Huntsville, Alabama, United States
- Haley, Heather L., Crestwood Medical Center, Huntsville, Alabama, United States
Introduction
Acute kidney injury (AKI) with systemic symptoms due to glomerular diseases like IgA-nephropathy (IgAN) and post-infectious glomerulonephritis (PIGN) can have overlapping features, posing diagnostic challenges. Since treatment strategies differ significantly, early serologic and tissue diagnosis, high clinical suspicion, and timely empiric therapy are critical for favorable outcomes.
Case Description
A 25-year-old male with hypertension, stage IV chronic kidney disease, familial hyperlipidemia, and asthma presented with progressive dyspnea and oliguria. He was recently hospitalized for hypertensive emergency (Cr 2.7 mg/dL) and had microscopic hematuria 2 years ago (Cr 1.2 mg/dL). On admission: Cr 8.0 mg/dL, BUN 64 mg/dL, leukocytosis. Urinalysis showed 3+ blood, 3+ protein, >182 RBCs/HPF. Imaging ruled out urinary obstruction. He developed worsening hypoxia and mild hemoptysis; chest imaging showed bilateral infiltrates suggesting pneumonia vs. pulmonary-renal syndrome. He was moved to the ICU and started on IV antibiotics and pulse-dose steroids.
Serologies were negative (ANCA, ANA, anti-GBM); complement levels were normal. Biopsy showed globally sclerosed glomeruli, 30-40% tubulointerstitial fibrosis (T1), moderate-severe mesangial proliferation (M1), endocapillary hypercellularity (E1), segmental sclerosis (S1), focal crescents (C1), and mild fibrinoid necrosis. Immunofluorescence revealed mesangial IgA (3+) and C3 (3+) in a starry-sky pattern. EM showed sparse deposits. Findings suggested chronic IgAN with superimposed PIGN. Dialysis was deferred as renal function stabilized.
He was discharged on an SGLT2 inhibitor, and urgent transplant referral was initiated.
Discussion
Suspicion for PIGN was initially low, as AKI coincided with a lung infection. Acute IgAN or ANCA-vasculitis were strongly considered, prompting pulse-dose steroids before biopsy or serology results. Biopsy later confirmed superimposed PIGN with chronic IgAN. Continuing IV antibiotics likely helped prevent or delay dialysis and reduce morbidity. This case highlights the lack of clear guidelines in overlaps between PIGN and acute IgAN. Treating both likely improved short-term outcomes and gave the patient a critical window for transplant evaluation, despite a poor prognosis from advanced chronic IgAN.