A case of a 25-year old male presenting with incidental finding of elevated creatinine, microscopic hematuria and proteinuria

Roderic Ng, Arriane Evangelista. MD

Introduction: IgA nephropathy (IgAN) is classically characterized by episodic hematuria associated with deposition of IgA in the mesangium conincident with mucosal infection. The diagnostic hallmark is seen through renal biopsy showing predominance of IgA deposits either alone or with IgG or IgM

Presentation of Case: A 25-year old male consulted for increasing creatinine, dipstick proteinuria and microscopic hematuria which were all incidentally found 3 months prior to consult. Percutaneous renal core biopsy revealed 7% cellular crescents, 43% fibrous crescents, 67% global glomerulosclerosis and 7% segmental glomerulosclerosis with acute tubular injury and moderate interstitial fibrosis and tubular atrophy. The patient was started on pulse steroid and IV cyclophosphamide and was able to tolerate three cycles of IV immunosuppressive therapy with note of decrease in serum creatinine from pretreatment levels.

Discussion and Conclusion: IgAN has a wide spectrum of clinical presentations, varying from isolated  hematuria  to  rapidly  progressive glumerulonephritis. Given the generally benign course of patients with IgA Nephropathy who have isolated hematuria, a renal biopsy is usually performed only if there are signs suggestive of a more severe or progressive disease such as persistent protein excretion above 1000 mg/day or an elevated serum creatinine concentration.Current recommendation for Crescentic IgAN involves the use of cyclophosphamide and corticosteroids.