Abstract: PUB267
Early Detection and Management of IgAN to Prevent Progression to ESRD
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Devinney, Annie B, Swedish Hospital, Chicago, Illinois, United States
- Pandya, Shan, Swedish Hospital, Chicago, Illinois, United States
- Humayun, Youshay, Associates In Nephrology SC, Chicago, Illinois, United States
- Anderson, Gregory, Swedish Hospital, Chicago, Illinois, United States
- Shetty, Ashwin R., Nephrology Associates, Oak Park, Illinois, United States
Introduction
IgA Nephropathy (IgAN) is the leading cause of nephritic syndrome worldwide, with significant morbidity and mortality with 50% of adults in the United States diagnosed with IgAN having CKD Stages 3-5. Typically patients present with hematuria in the setting of upper respiratory infection or gastro-intestional illness, however may also present with proteinuria, microscopic hematuria, or hypertension alone. We present a CKD4 patient who presented in renal failure ultimately diagnosed with IgAN.
Case Description
A 73 YO F with PMHx of HTN, CKD4, T2DM who presented to the ED for high blood pressure and abnormal labs. Over the last week she noted worsening headache, intermittent BLE edema, and decreased UOP with red tinged urine. Her labs prior to admission noted a creatinine (Cr) of 8.3 mg/dL (baseline 2) and Urine microalbumin/Cr ratio of 435. On admission she had hypertensive emergency. While admitted she developed worsening edema and hyponatremia. She was started on LR, and secondary workup was sent for glomerulonephritis. 24 Hour urine protein was 12.06 G/24H. Despite appropriate treatment, her Cr and symptoms failed to improve. Ultimately she required initiation of dialysis. Secondary workup returned negative. She underwent IR guided biopsy which showed IgAN with severe chronicity, severe tubular atrophy and interstitial fibrosis, and severe hypertensive arteriosclerosis.
Discussion
While a majority of patients present with asymptomatic hematuria, some patients present in frank renal failure. When patients present with unexplained proteinuria with or without renal dysfunction, IgAN should be considered. Secondary workup is often negative and the only confirmartory test is biopsy with immunflorescence. Although only a small percentage of patients present this way, cases like these highlight the importance of early recognition and treatment to prevent ESRD.
A.KR-24-1479 IgA Pronase IF granular mesangial staining. B.PAS stain diffuse global glomerulosclerosis