Dr Ting chia Lew1, Dr SRIDEVI GOVINDARAJULU1
1Renal Unit Toowoomba Hospital, Toowoomba, Australia
Biography:
Dr Ting Chia Lew is the Renal Advanced Trainee in Toowoomba Hospital, with special interest in dialysis and Kidney Supportive Care.
Background:
Glomerular disease as part of paraneoplastic syndrome is a well- known phenomenon associated with solid tumour organ. The entity of this disease that is infrequently seen includes paraneoplastic vasculitis with renal involvement, for which its diagnosis has been traditionally difficult in patients with acute deterioration in renal function concurrently and new diagnosis of a malignancy.
Case Presentation:
We present a 82-year-old gentleman who developed acute kidney injury during his admission for chest pain secondary to atrial flutter, and Enterococcus faecalis bacteremia treated with IV Ampicillin following diagnosis of adenocarcinoma in the descending colon a week prior. His creatinine increased from 90 umol/L to 350 umol/L, urine microscopy and culture showed >500 x 10^6/L of erythrocytes, urine protein creatinine ratio 125 g/mol creat, urine albumin creatinine ratio 38 g/mol creat, p-ANCA, c-ANCA, MPO negative but PR3 59 CU, anti- GBM negative. Ultrasound of renal tract was unremarkable. There was pauci-immune focal necrotising glomerulonephritis with cellular crescents and normocellular glomeruli on renal biopsy. Paraneoplastic vasculitis was suspected and 50 mg prednisolone was commenced. His kidney function improved following prednisolone course to creatinine of 150 umol/L. Patient tolerated chemotherapy for his adenocarcinoma and renal function has been stable with negative ANCA since.
Conclusion:
This is an uncommon case of paraneoplastic vasculitis with positive PR3. The temporal relationship between the diagnosis of adenocarcinoma and onset of vasculitis raised the suspicion into correlation between these conditions, and the resolution of the vasculitis following the treatment of the adenocarcinoma further proved the dependency of the diseases. The awareness of this condition should be raised as high level of suspicion is required for the recognition and subsequently management of paraneoplastic vasculitis.