SHM Converge Scientific Abstract ePoster Gallery-Unmasking the True Culprit: Revisiting the Diagnosis of Acute Kidney Injury in a Young Patient

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This case describes a 25-year-old man with hypertension and a prior diagnosis of post-streptococcal glomerulonephritis (PSGN), made two years earlier without kidney biopsy. He presented for evaluation of worsening renal function after an outside creatinine of 2.68 mg/dL had already been noted two months before. At presentation, he was asymptomatic but had severe hypertension, tachycardia, and marked kidney dysfunction with creatinine rising to 3.95 mg/dL and BUN 52 mg/dL.<br /><br />Urine studies showed nephrotic-range proteinuria and hematuria, suggesting an active glomerular process rather than resolved PSGN. Renal ultrasound showed normal-sized kidneys but changes consistent with medical renal disease. Serologic testing for autoimmune and infectious causes was unrevealing. Because the progression of kidney disease and heavy proteinuria did not fit the expected course of PSGN, nephrology recommended a kidney biopsy.<br /><br />Biopsy results revealed advanced IgA nephropathy with severe chronic damage, including 90% interstitial fibrosis and tubular atrophy, indicating irreversible chronic kidney disease. The prior PSGN diagnosis likely created anchoring bias and delayed recognition of the true disease.<br /><br />He was treated with prednisone, later switched to budesonide, and an ACE inhibitor was started outpatient. The case emphasizes that in young patients with progressive kidney dysfunction, nephrotic-range proteinuria, and uncertain prior diagnoses, clinicians should reconsider assumptions and pursue biopsy when appropriate to achieve earlier and more accurate diagnosis.

Asset Subtitle

Navin Bhatt

Meta Tag

Author List Jorge Kourie, Navin Bhatt, Shristi Nepal, Sunil Bogati, Viraj Joshi

Category Clinical Vignettes

Concept Kidney Function Decline

Concept Glomerular Disease

Concept Kidney Biopsy

Concept Nephrotic-Range Proteinuria

Concept Hematuria

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai / Elmhurst

Presenting Author Navin Bhatt

Track Adult

Keywords

IgA nephropathy

post-streptococcal glomerulonephritis

kidney biopsy

nephrotic-range proteinuria

hematuria

chronic kidney disease

interstitial fibrosis

tubular atrophy

hypertension

anchoring bias

Kidney Function Decline

Glomerular Disease

Kidney Biopsy

Nephrotic-Range Proteinuria

Hematuria