MAYY HAMDE1, AKSHAY ATHAVALE1,2, CELINE FOOTE1,2
1Department of Renal Medicine, Concord Repatriation and General Hospital, Concord, Australia, 2Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia
Background
IgA nephropathy with minimal change disease is a rare clinical entity in adults, with distinct clinicopathological features and unclear prognostic implications. Treatment involves pharmacotherapy directed toward minimal change disease. We report a case of mixed IgA nephropathy and minimal change disease, with characteristic clinical and pathological features of a dual glomerulopathy.
Case Report
A 41 year old gentleman was referred for investigation of new onset nephrotic syndrome. Background history was significant for psoriatic arthritis treated with certolizumab. On presentation, he was grossly oedematous, with evidence of ascites and pulmonary oedema. Blood pressure was 130/80 mmHg and there had been 5 kg weight gain over two weeks.
Investigations demonstrated serum creatinine (sCr) of 60umol/L, estimated glomerular filtration rate (eGFR) > 90mL/minute. Serum albumin was 17 g/L and total cholesterol 12.1 mmol/L. 24-hour urine protein was 17g and protein creatinine ratio (PCR) was 1739 mg/mmol. Urine sediment demonstrated microhaematuria and 75% dysmorphic red cells.
Kidney biopsy demonstrated increased mesangial cellularity with one fibrocellular crescent. Immunofluorescence was significant for IgA and lambda immune deposits. There was diffuse (approximately 80%) effacement of the podocyte foot processes on electron microscopy.
Treatment with oral prednisone, 50 mg, resulted in reduced urine PCR to 12 mg/mmol. Serum albumin and total cholesterol normalised to 38g/L and 3.2mmol/L respectively. Urine microscopy normalised with no haematuria. The patient continues on 10 mg prednisone daily and remains in remission.
Conclusion
We present a case of biopsy proven concurrent IgA nephropathy and minimal change disease manifesting as florid nephrotic syndrome. Treatment is clear and directed towards minimal change disease, but prognostic implications including risk of relapse and progression to end-stage kidney disease remain unclear.
Biography:
‘Bio to come’