Abstract: FR-PO0766
Sniffles to Hemodialysis: A Case of c-ANCA-Positive Vasculitis
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Tanasiuk, Jessee T., The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, United States
- Rajpal, Minesh, Southwest Kidney Institute PLC, Tempe, Arizona, United States
Introduction
Patients with ANCA vasculitis often get misdiagnosed with infection or fluid overload. In this case, our patient’s upper respiratory symptoms progressed despite several courses of empiric antibiotics. He also developed systemic symptoms and renal dysfunction, leading us to suspect an autoimmune cause. C-ANCA vasculitis can affect both the upper and lower respiratory tracts, ophthalmologic, and renal systems [1].
Case Description
65 y/o M w/ weakness, fatigue, loss of appetite, LE swelling, and sinus congestion despite outpt abx x3. WBC 16.1, Hb 10.1, PLT 569, Cr 3.93 (b 1.0), sodium 128 mmol/L, CRP 103.9 mg/L, ESR 45 mm/hr. UA small protein, large blood. Medical renal disease on US. C3 95, C4 12, ANA 1:160, IgG 1012, IgA 179, IgM 124, C-ANCA 1:160. ATI on renal biopsy, however was suboptimal with no glomeruli. Hospital course complicated by hemoptysis and hypoxemic respiratory failure. Birmingham Vasculitis Activity Score 22. He received HD (continued after discharge), plasmapheresis x5, methylprednisolone, and rituximab. Urine output increased, energy and appetite returned.
Discussion
This patient presented several times with nonspecific complaints of sinus congestion and constitutional symptoms. He received several rounds of antibiotics before noninfectious etiologies were considered. As a result, the patient had a delay of several months between symptom onset and disease-specific treatment. Differentiating between infectious and autoimmune causes of upper respiratory symptoms can prove difficult; when symptoms progress despite treatment with empiric antibiotics, resistance and alternative diagnoses should be considered.
| Hospital Day | 1 | 2 | 3 | 4 | ... | 9 | ... | 23 |
| Hb (g/dL) | 10.1 | 8.9 | 8.6 | 8.1 | 6.0 | 6.9 | ||
| WBC (K/uL) | 16.1 | 15.9 | 14.2 | 23.7 | 27.2 | 13.8 | ||
| Glucose (mg/dL) | 114 | 103 | 142 | 153 | 115 | 109 | ||
| Sodium (mmol/L) | 128 | 130 | 133 | 137 | 133 | 135 | ||
| Potassium (mmol/L) | 4.5 | 4.5 | 5.1 | 5.3 | 5.0 | 4.5 | ||
| BUN (mg/dL) | 74 | 77 | 81 | 97 | 59 | 54 | ||
| Creatinine (mg/dL) | 3.93 | 4.01 | 4.23 | 4.63 | 2.81 | 3.06 | ||
| eGFR (mL/min/1.73 m2) | 16 | 15 | 14 | 13 | 23 | 21 |