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ANCA and IgA glomerulonephritis all in one: prognosis and complications

Pitchaphon Nissaisorakarn1, Vivette D'Agati2, Kisra Anis1

  • 1Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, NY, USA.

BMJ Case Reports
|October 12, 2017
PubMed

Insights

This case study highlights a rare co-occurrence of IgA nephropathy and ANCA-associated glomerulonephritis. Elderly patients may benefit from reduced-dose immunosuppression to mitigate severe infectious complications.

Area of Science:

  • Nephrology
  • Immunology
  • Internal Medicine

Background:

  • Presents a complex case of a 75-year-old woman with pre-existing chronic kidney disease, hypertension, and diabetes.
  • The patient exhibited acute kidney injury, nephrotic-range proteinuria, and a positive antimyeloperoxidase antibody.

Observation:

  • Renal biopsy confirmed IgA nephropathy with superimposed pauci-immune ANCA-associated crescentic glomerulonephritis.
  • Treatment involved pulse intravenous methylprednisolone, cyclophosphamide, and plasmapheresis.
  • The patient experienced significant infectious complications, including influenza A, Rothia bacteraemia, and herpes zoster, following cyclophosphamide therapy.

Findings:

  • Reviews the prevalence, treatment, and prognosis of coexistent IgA nephropathy and pauci-immune ANCA-associated crescentic glomerulonephritis.
  • Suggests that reduced-dose immunosuppressive regimens may be beneficial for elderly patients.
  • This approach could potentially decrease infectious complications without sacrificing treatment effectiveness.

Implications:

  • Highlights the increased risk of severe infections in elderly patients undergoing immunosuppressive therapy for glomerulonephritis.
  • Proposes a modified treatment strategy for older individuals with this dual kidney pathology.
  • Emphasizes the need for careful patient selection and monitoring in managing rare autoimmune kidney diseases.

Keywords:
acute renal failurenephrotic syndromeproteinureavasculitis

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