SHM Converge Scientific Abstract ePoster Gallery-A Case of Rapidly Progressing Fibrillar Glomerulonephritis

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This case describes a 64-year-old woman with hereditary transthyretin amyloidosis (hATTR) who presented with bilateral thigh pain, vomiting, anorexia, and rapidly worsening kidney function. Because hATTR kidney involvement is usually a more gradual process, her unexpectedly fast decline prompted further evaluation.<br /><br />On admission, she had acute kidney injury with elevated creatinine, uremia, hypoalbuminemia, and a supratherapeutic INR while taking warfarin for atrial fibrillation. Imaging showed mild pulmonary edema, anasarca, and small ascites. Her condition progressed to oliguric stage III AKI with symptomatic hyperkalemia requiring two emergency dialysis sessions.<br /><br />A kidney biopsy revealed fibrillary glomerulonephritis with focal fibrinoid necrosis, a rare immune-complex mediated glomerular disease seen in only 0.5%–1% of native kidney biopsies. It is characterized by Congo red–negative, amyloid-like fibrils and is often associated with malignancy or autoimmune disease. Prognosis is generally poor, with many patients developing end-stage renal disease within a few years.<br /><br />The patient was treated empirically with intravenous methylprednisolone for three days, then transitioned to high-dose oral prednisone. Her renal function improved substantially, returning to near baseline by discharge, and she was sent home on maintenance prednisone while awaiting specialist input and possible rituximab therapy.<br /><br />The key lesson is that patients with multi-organ disease may have more than one concurrent pathology. Clinicians should keep a broad differential and let the tempo of symptoms guide the workup, especially when a presumed explanation does not match the clinical course.

Asset Subtitle

Harris Majeed

Meta Tag

Author List Abu Baker Sheikh, Eesha S. Bashir, Harris Majeed

Category Clinical Vignettes

Concept Fibrillary Glomerulonephritis

Concept Rapidly Progressive Kidney Injury

Concept Kidney Biopsy

Concept Amyloidosis

Concept IgG Positivity

Distinguished Non-Finalist

Presenter Organization UNM Hospital

Presenting Author Harris Majeed

Track Adult

Keywords

hereditary transthyretin amyloidosis

acute kidney injury

fibrillary glomerulonephritis

kidney biopsy

oliguric stage III AKI

hyperkalemia

dialysis

prednisone

methylprednisolone

multi-organ disease

Fibrillary Glomerulonephritis

Rapidly Progressive Kidney Injury

Kidney Biopsy

Amyloidosis

IgG Positivity