SHM Converge Scientific Abstract ePoster Gallery-Insights in Iga Nephropathy Management From an Interesting Patient Case

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This case report describes a severe presentation of IgA nephropathy in a 22-year-old man with no prior medical history. He presented with a three-week history of headache, nausea, and vomiting, and was found to have a hypertensive emergency, markedly elevated creatinine and BUN, anemia, hematuria, and heavy proteinuria. His family history was notable for a father with end-stage renal disease requiring transplant.<br /><br />After stabilization with IV fluids and nicardipine, further evaluation including serologies, urine protein electrophoresis, and renal ultrasound was unrevealing. Kidney biopsy confirmed IgA nephropathy with endocapillary proliferation, crescentic glomerulonephritis, malignant hypertension, extensive chronic damage, and high-risk Oxford MEST-C features (M1, E1, S1, T1-C1), including global sclerosis and significant fibrosis.<br /><br />Because of the patient’s young age and the potential for renal recovery, nephrology pursued an aggressive renal-preservation approach. Treatment included IV methylprednisolone followed by a prolonged prednisone taper, three sessions of plasma exchange, short-term azathioprine, and temporary hemodialysis.<br /><br />The authors emphasize that IgA nephropathy has a wide clinical spectrum, ranging from benign intermittent hematuria to progressive disease leading to end-stage kidney disease. Management should be individualized, but KDIGO guidelines recommend supportive care, blood pressure control, renin-angiotensin system blockade, and lifestyle/risk factor modification, with glucocorticoids considered if proteinuria remains above threshold after adequate supportive therapy.<br /><br />Overall, this case highlights that IgA nephropathy can present fulminantly with severe renal dysfunction and malignant hypertension, and early biopsy-driven treatment may be important to preserve kidney function.

Asset Subtitle

Colin MacKay

Meta Tag

Author List Colin MacKay, Eric Chan, Jesse E. Doyle, Vijay Bhasin

Category Clinical Vignettes

Concept IgA Nephropathy

Concept Hematuria

Concept Proteinuria

Concept Crescentic glomerulonephritis

Concept Blood Pressure Control

Distinguished Non-Finalist

Presenter Organization Indiana University School of Medicine Internal Medicine Residency (Southwest)

Presenting Author Colin MacKay

Track Adult

Keywords

IgA nephropathy

crescentic glomerulonephritis

malignant hypertension

acute kidney injury

proteinuria

hematuria

kidney biopsy

plasma exchange

prednisone taper

end-stage renal disease

IgA Nephropathy

Hematuria

Proteinuria

Crescentic glomerulonephritis

Blood Pressure Control