SHM Converge Scientific Abstract ePoster Gallery-Plasma Exchange Therapy Indicated for Severe Kidney Injury and Gpa

Pdf Summary

This case report describes a 52-year-old woman with chronic sinusitis and recurrent pneumonia who presented with fatigue, malaise, weight loss, transaminitis, and new acute kidney injury. Initial evaluation showed rising creatinine, oliguria, and hyperkalemia. Chest X-ray demonstrated a patchy right middle lobe airspace opacity, raising concern for pneumonia, though alveolar hemorrhage and pneumothorax were excluded.<br /><br />Because of the combination of pulmonary symptoms and severe renal dysfunction, granulomatosis with polyangiitis (GPA) was suspected. She was treated with Solu-Medrol followed by prednisone, with clinical improvement. Rheumatology recommended rituximab and blood transfusion, and avacopan was also started. When her creatinine rapidly worsened to 5.9, she developed oliguria and hyperkalemia and was transferred to the ICU for plasma exchange (PLEX). She ultimately underwent five PLEX sessions.<br /><br />A kidney biopsy on hospital day 4 showed diffuse crescentic pauci-immune glomerulonephritis, confirming ANCA-associated renal vasculitis consistent with GPA. Five days after discharge, she returned with hemoptysis and was admitted to the ICU for suspected diffuse alveolar hemorrhage. She received three units of packed red blood cells and continuous renal replacement therapy for AKI. Her hemoptysis improved with steroids and PLEX, and she underwent three additional PLEX sessions. She improved by hospital day 5 and was discharged on day 9.<br /><br />The authors emphasize that although PLEX is commonly used in severe GPA with kidney injury and/or pulmonary hemorrhage, its benefit remains controversial and not fully established. This case highlights the ongoing debate over when plasmapheresis should be used in ANCA-associated vasculitis.

Asset Subtitle

Devesh Kumar

Meta Tag

Author List Ana Johnson Escauriza, Devesh Kumar, Pinky Jha, Shanna Su

Category Clinical Vignettes

Concept Granulomatosis with Polyangiitis

Concept Pauci-Immune Crescentic Glomerulonephritis

Concept Acute Kidney Injury

Concept ANCA-Associated Vasculitis

Concept Respiratory Tract

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Devesh Kumar

Track Adult

Keywords

granulomatosis with polyangiitis

ANCA-associated vasculitis

crescentic glomerulonephritis

pauci-immune nephritis

acute kidney injury

diffuse alveolar hemorrhage

plasma exchange

rituximab

prednisone

hemoptysis

Granulomatosis with Polyangiitis

Pauci-Immune Crescentic Glomerulonephritis

Acute Kidney Injury

ANCA-Associated Vasculitis

Respiratory Tract