SHM Converge Scientific Abstract ePoster Gallery-From Silent Disease to Catastrophe: Advanced Iga Nephropathy Presenting With Nephrotic-Nephritic Syndrome and Stress Induced Cardiomyopathy

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This case describes a 36-year-old woman with no prior medical history who presented with progressive shortness of breath, orthopnea, leg edema, severe hypertension, anemia, and acute renal failure. Her labs showed creatinine 10.8 mg/dL, BUN 112 mg/dL, and nephrotic-range proteinuria with hematuria, suggesting a mixed nephrotic-nephritic syndrome. Cardiac evaluation revealed reduced ejection fraction (25–30%) with global hypokinesis, consistent with stress-induced cardiomyopathy.<br /><br />Extensive serologic testing for alternative causes of glomerulonephritis was negative, while serum IgA was elevated. Renal biopsy confirmed advanced IgA nephropathy with severe chronic damage, including 60% interstitial fibrosis and tubular atrophy, crescents, microangiopathic changes, and marked podocyte injury. These findings explained the rapid and severe decline in kidney function and the heavy proteinuria. The biopsy also showed that the disease was already advanced, limiting the potential benefit of immunosuppressive therapy. High-dose steroids were started initially but later discontinued, and the patient ultimately required maintenance hemodialysis with referral for kidney transplant evaluation.<br /><br />Her severe uncontrolled hypertension, profound anemia, and uremia likely created major physiologic stress, contributing to reversible cardiac dysfunction. After several dialysis sessions and blood pressure control, her ejection fraction improved to 55–60%, supporting a diagnosis of stress-induced cardiomyopathy triggered by her hypertensive crisis and hemodynamic instability rather than primary structural heart disease.<br /><br />The report emphasizes that IgA nephropathy can rarely present catastrophically with nephrotic-nephritic syndrome and advanced irreversible fibrosis, especially when compounded by chronic uncontrolled hypertension. It also highlights that hypertensive emergencies in this setting can precipitate transient cardiomyopathy. Early recognition, aggressive blood pressure management, renal support, and coordinated multidisciplinary care are essential to prevent irreversible kidney damage and improve both renal and cardiac outcomes.

Asset Subtitle

Anab Rehan Taseer

Meta Tag

Author List Anab Rehan Taseer, Micheal Iannetti

Category Clinical Vignettes

Concept IgA Nephropathy

Concept Nephrotic Syndrome

Concept Nephritic Syndrome

Concept Kidney Biopsy

Concept Malignant Hypertension

Distinguished Non-Finalist

Presenter Organization Department of Internal Medicine, Charleston Area Medical Center, Charleston, West Virginia

Presenting Author Anab Rehan Taseer

Track Adult

Keywords

IgA nephropathy

nephrotic-nephritic syndrome

acute renal failure

hypertensive emergency

stress-induced cardiomyopathy

renal biopsy

proteinuria

hematuria

hemodialysis

kidney transplant

IgA Nephropathy

Nephrotic Syndrome

Nephritic Syndrome

Kidney Biopsy

Malignant Hypertension