Abstract: FR-PO0450
Rare Case of Syphilis-Induced Rapidly Progressive Glomerulonephritis
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Johar, Leepakshi, Alta Bates Summit Medical Center - Summit Campus, Oakland, California, United States
Introduction
Syphilis induced rapidly progressive glomerulonephritis (RPGN) is a rare but serious complication, often due to immune complex deposition or vasculitis. There is rapid loss of kidney function which can often lead to end-stage renal disease if not promptly treated. Glomeruli become inflamed and damaged leading to symptoms such as acute kidney injury, hematuria, proteinuria, edema, hypertension. Untreated RPGN can typically progress to end-stage renal disease.
Case Description
58 year old homeless male with history of hypertension, methamphetamine abuse presented to the emergency department with chronic bilateral lower extremity stasis dermatitis with purulent drainage. Endorsed methamphetamine use four days prior to admission, but denied IV drug use. Has unstable housing for many years.
On presentation, patient had creatinine of 3.42 with baseline creatinine of 1.00 (9 years ago). Patient has no prior history of chronic kidney disease. Urinalysis demonstrated hematuria, proteinuria, and pyuria. Renal ultrasound showed increased echogenic bilateral kidneys. Was started on ceftriaxone for urinary tract infection. Received fluids on admission, but creatinine continued to rise. Patient was also treated for uncontrolled hypertension.
Protein quantification was 4.7 g. RBC quantification was greater than 180 RBCs. RPR and FTA-ABS were positive. C3 and C4 were low. Rheumatoid factor, antinuclear antibody, MPO, PR3, ANCA were negative.
Given that patient continued to have rising creatinine, peaking at 5.23, patient was started on dialysis. Renal biopsy demonstrated cresenteric glomerular nephritis with immune complex and C3 deposits. Subepithelial deposits in marked standing of C3 were also noted and medulla demonstrated tubular injury. Patient was diagnosed with syphilis induced RPGN. Patient was treated with doxycycline. Steroids were not given in setting of active skin infections. Creatinine improved to 3.51 one month after discharge from the hospital with ongoing dialysis.
Discussion
Since syphilis induced RPGN is rare, there are only 3 case reports per literature review regarding syphilis induced RPGN. In all three case reports, diagnostic workup was done to rule out more common causes of immune complex mediated glomerular nephritis. Patients were treated with penicillin G and/or steroids. There are limited studies on whether steroids are effective in treating syphilis induced RPGN while concurrently treated with antibiotics.