SAT-426 MEMBRANO-PROLIFERATIVE GLOMERULONEPHRITIS POST DENGUE VIRUS FEVER: A CASE REPORT

Abstract

Dengue belongs to the Flaviviridae family of viruses and is responsible for nearly 100 million cases of dengue fever. Dengue fever affects the kidneys in various ways that range from glomerulonephritis up to acute kidney injuries. Spontaneous recovery is expected. Renal involvement may occur in dengue hemorrhagic fever in the absence of shock, sepsis, hemolysis, or rhabdomyolysis. In clinical practice, acute glomerulonephritis is a rare complication. Mesangial proliferation and immune complex deposition are the dominant histological features of dengue-associated glomerulonephritis. Case Report: We present a 61-year-old, male medically free with normal serum creatinine (Scr) one month ago. He travelled to his countryside house in the Philippines and was been bitten by many mosquitos in one night; later, he developed a high- grade fever with hemolytic anemia and diagnosed with dengue fever based on a positive dengue serology test. He was admitted to the hospital. Intravenous (IV) fluids and medications were initiated in his hometown hospital. Before completing treatment, his renal function worsened, so he travelled back to Saudi Arabia and came immediately to our hospital. In the out-patient department (OPD), he was distressed with hypertensive urgency (200/100), generalized anasarca, epigastric pain and acute kidney injury with a serum creatinine of 2.8 mg/dl that increased to 3 mg/dl after one day. His renal ultrasound revealed grade I nephropathy and normal size with no pelvicalceal changes. Proteinurea was evident in urine analysis, and a 24 h urine protein revealed 14 gm/day. A cholesterol level of 301 mg/dl and a serum albumin level of 2.9 gm/dl were detected. Stool analysis was positive for Helicobacter. pylori antigen. After control of blood pressure and in view of the classic picture of nephrotic syndrome, poor improvement of kidney function after receiving conservative measures, a renal biopsy was done, which and revealed membranoproliferative glomerulonephritis (GN). The patient was maintained on a high dose of steroids (60 mg per day) and mycophenolate mofetil 1 gm twice per day for one month. A significant improvement in kidney function was achieved, and Scr returned to normal (0.9 mg/dl), which was followed by tapering of oral steroids. Urine protein improved from 14 gm/day to 315 mg/day then zero, and serum albumin was 4.29 gm/dl after three months of treatment. In conclusion, this case elaborates the possible pathogenesis of membranoproliferative GN due to dengue fever.View Large Image Figure ViewerDownload Hi-res image Download (PPT)