#2627 IGA-DOMINANT POSTINFECTIOUS GLOMERULONEPHRITIS, “THE OTHER SIDE OF THE COIN”: A CASE REPORT

Abstract

Abstract Background and Aims Postinfectious glomerulonephritis (PIGN) is a disease presented as nephritic syndrome with hypocomplementemia usually secondary to a skin or throat infection by beta hemolytic Streptococcus and with histopathological findings of endocapillary proliferation, C3 deposits along the capillary wall and mesangium, subepithelial immune complex deposits and IF positive for IgG. There are other unusual presentations of PIGN with IgA dominance or C3-IgA codominance. Method A 58-year-old Guatemalan male, with history of one-week duration pain in the right upper quadrant associated with jaundice, diagnosed with cholangitis and intravenous antibiotics use. History of consumption of 10 beers a month for 40 years. No other medical history. During hospitalization, presented a lower-limb cellulitis, for which clindamycin was started. Blood cultures were taken and were positive for S. epidermidis and AKI (Cr 2.84 mg/dl) was observed, associated with de novo appearance of hematuria (80% acanthocytes), proteinuria (580mg/day) and hypertension. Diagnostic approach for nephritic syndrome was performed obtaining: C3 0.592 (low) ANA, ANCAs, HIV-HCV-HBV negative, total cholesterol 184 mg/dl, albumin 2.78 g/dl. Results Renal biopsy was performed and reported: PIGN with IgA dominance with extra capillary proliferation. Reason why pulses of methylprednisolone were given for 3 days and then oral prednisone (1 mg/kg/day), progressively decreasing it until it was discontinued. Resolved the soft tissue infection and was discharged. At 1-month follow-up as outpatient, was evidence of a 50% decrease in proteinuria compared to baseline, disappearance of hematuria but with persistent of high Cr (2.09 mg/dl). Conclusion IgA-dominant PIGN is characterized by usually presenting in patients >60 years with DM, alcohol consumption and staphylococcal skin infections. It can present hypocomplementemia and histopathological findings are characterized by IgA dominance over C3 and no IgG in IF. Elevated serum IgA levels may be involved in the pathogenesis. Treatment is based on eradication of the infection with antibiotics and in some cases the use of steroids is suggested depending on the aggressiveness of the lesion and the presence of crescents in the renal biopsy. It has worse prognosis than the traditional PIGN.