Abstract: SA-PO0916
Pericarditis as the Initial Manifestation of IgA Vasculitis with Concurrent IgAN
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
- Gerlt, Deitrich, Methodist Health System, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Dallas Nephrology Associates, Dallas, Texas, United States
Introduction
IgA nephropathy (IgAN) is the most common primary glomerulonephritis, often identified incidentally through microscopic hematuria or proteinuria. Although primarily renal-limited, IgAN shares pathogenic features with IgA vasculitis, a systemic small-vessel vasculitis characterized by IgA-dominant immune complex deposition. Cardiac involvement is rare, and pericarditis as an initial presentation is particularly uncommon. We report a case of pericarditis as the first manifestation of IgA vasculitis with concurrent IgAN.
Case Description
A 58 YO female with CKD 3b and HTN presented with pleuritic chest pain. Labs showed WBC 12.4 ×10^3/μL, AKI (Cr 2.30 mg/dL; baseline 1.6), BUN 44 mg/dL, BNP 1830 pg/mL, and ESR >130 mm/hr. ECG demonstrated acute pericarditis; TTE showed no effusion. UA revealed 3+ blood, 2+ protein, 343 RBCs, and RBC casts. ANA was positive (1:40, speckled); C3, C4, and anti-dsDNA were normal. She was treated with colchicine 0.3 mg daily, lisinopril held, and discharged.
At follow-up, chest pain persisted. Prednisone was initiated, and lisinopril resumed. Despite transient improvement, proteinuria worsened (UPC 3009 mg/g) with persistent hematuria, prompting kidney biopsy. Histopathology confirmed IgAN with mesangioproliferative features, segmental scarring, and 50% interstitial fibrosis. IF showed mesangial IgA with kappa and lambda co-deposition. EM confirmed mesangial deposits and podocyte foot process effacement.
She was managed with dapagliflozin 10 mg daily, lisinopril 10 mg daily, colchicine 0.3 mg daily, and a prednisone taper. Renal function returned to baseline (Cr 1.59 mg/dL), and chest pain fully resolved.
Discussion
This case highlights the importance of recognizing systemic vasculitis in patients with unexplained pericardial disease, particularly when accompanied by urinary abnormalities suggestive of glomerular pathology. Early recognition and appropriate immunosuppressive therapy proved beneficial towards recovery of renal function.
Diffuse ST segment elevation and PR interval depression, consistent with acute pericarditis.