Abstract: TH-PO0081
A Complex Case of AKI and Hematuria
Session Information
- AKI: Pathogenesis and Disease Mechanisms
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Salam, Rania, Stony Brook University Hospital, Stony Brook, New York, United States
- Koraishy, Farrukh M., Stony Brook University Hospital, Stony Brook, New York, United States
- Andrade, Katherine, Stony Brook University Hospital, Stony Brook, New York, United States
Introduction
Anti-glomerular basement membrane (GBM) disease is a rare form of glomerulonephritis (GN) that can progress rapidly to end-stage kidney disease (ESKD). While the exact trigger is often unknown, coronavirus disease 2019 (COVID-19) has been implicated in some cases.
Case Description
A 55-year-old female with a history of hypertension and nephrolithiasis status post extracorporeal shock wave lithotripsy (ESWL) six months prior presented with acute kidney injury (AKI), hematuria, upper respiratory symptoms, and a positive COVID-19 PCR. She had received two COVID-19 vaccine doses in 2021 and had no prior diagnosis of COVID-19. Her baseline serum creatinine (SCr) was 0.9 mg/dL; at presentation, it was 2.51 mg/dL. Urinalysis was positive for blood and protein, with no signs of pulmonary hemorrhage. She was started on remdesivir. Initial imaging showed a non-obstructing right renal stone without hydronephrosis, but SCr continued to rise, peaking at 5.18 mg/dL. Repeat imaging revealed frank hydronephrosis, prompting bilateral ureteral stent placement. Despite intervention, renal function worsened, and hematuria persisted. Serology was negative except for markedly elevated anti-GBM antibody titers. Empiric pulse steroids and plasmapheresis were started. Renal biopsy showed diffuse necrotizing and crescentic GN with linear IgG deposits, confirming anti-GBM disease. At biopsy, creatinine was 9.2 mg/dL. Cyclophosphamide was added, but the patient progressed to uremia and anuria, requiring hemodialysis. She was discharged stable on outpatient dialysis.
Discussion
This case underscores the diagnostic complexity of simultaneous AKI and hematuria from both obstructive uropathy and anti-GBM disease. While nephrolithiasis is common and easily identified via imaging, anti-GBM disease is rare and may be overlooked. ESWL and recent COVID-19 may serve as potential triggers. Clinicians should maintain a low threshold for evaluating anti-GBM disease in similar presentations.