SHM Converge Scientific Abstract ePoster Gallery-Unmasking the Uncommon: A Unique Presentation of Iga Nephropathy in a Geriatric Patient With Acute Kidney Injury

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This case report describes an atypical presentation of IgA nephropathy in a 70-year-old man with hypertension and chronic sinusitis who developed acute kidney injury (AKI) after an episode of gross painless hematuria. Although IgA nephropathy is the most common primary glomerulonephritis, it typically affects younger men and usually presents with episodic hematuria, often after upper respiratory infections, plus microscopic hematuria and proteinuria. Severe AKI and presentation in older adults are uncommon.<br /><br />The patient arrived with sinus and respiratory symptoms, hypertensive emergency, and elevated kidney function tests (BUN 32 mg/dL, creatinine 4.42 mg/dL). Urinalysis showed blood and protein, and imaging revealed a left renal stone, though no renal artery stenosis was found. Despite fluids and antibiotics, his creatinine rose to a peak of 6.09 mg/dL. Further workup showed 1.5 g of proteinuria and no monoclonal gammopathy. A kidney biopsy confirmed IgA nephropathy with acute tubular necrosis and minimal chronic scarring, without crescents.<br /><br />Because rapidly progressive glomerulonephritis was initially a concern, he was treated with high-dose IV methylprednisolone followed by oral prednisone. His kidney function partially improved, and he was discharged with creatinine 4.98 mg/dL. Steroids were later discontinued as an outpatient due to age and the presence of acute tubular necrosis, and creatinine further improved to 3.39 mg/dL with plans for losartan initiation.<br /><br />The report emphasizes that IgA nephropathy should remain in the differential diagnosis for AKI in older adults when hematuria is present. Early recognition and biopsy-based diagnosis are important to guide treatment and reduce the risk of chronic kidney disease progression.

Asset Subtitle

Taylor Karns

Meta Tag

Author List Aqeel Khanani, Taylor Karns, Yusuf Buxamusa

Category Clinical Vignettes

Concept IgA Nephropathy

Concept Kidney Biopsy

Concept IgA Deposition

Concept Hematuria

Concept Gross Hematuria

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Hospital

Presenting Author Taylor Karns

Track Adult

Keywords

IgA nephropathy

acute kidney injury

gross hematuria

older adults

kidney biopsy

acute tubular necrosis

proteinuria

hypertensive emergency

chronic sinusitis

glomerulonephritis

IgA Nephropathy

Kidney Biopsy

IgA Deposition

Hematuria

Gross Hematuria