Maria Tanvir Batool
Posters-Accepted Abstracts: Med Surg Urol
Introduction: IgA nephropathy is the most common lesion found to cause primary glomerulonephritis and frequently presents with asymptomatic haematuria. Two common presentations of patients with IgA nephropathy are episodic gross haematuria and persistent microscopic haematuria. Pulmonary capillaritis and pulmonary haemorrhage is a rare manifestation in patients with IgA nephropathy. I 30-40% patientsâ?? presents with asymptomatic haematuria and less than 10% develop slowly progressive decline in a renal function. Pulmonary haemorrhage has been very uncommonly associated with IgA nephropathy although it is frequently seen in other glomerulonephritides. We describe a well proven case of IgA nephropathy associated with severe haemoptysis and respiratory failure as the initial presentation of IgA nephropathy. Case presentation: A 26 year old male presented to Allied Hospital Faisalabad, Pakistan with a histroy of eye and ear problems, 3 week history of cough and haemoptytis, physical examination showed blood pressure 140/70, pulse rate 100 beat per min, temperature was 36.8o C, oxygen saturation 93% on a non rebreather. LAB investigations revealed HB 6.6, hematocrit 20.9, BUN 124, creatinine 14, urinalysis was positive for blood with 1048 blood cells, serum markers for HCV, HBV, HIV are negative. Serum immnoglobulin and complements are normal. A chest CT scan showed bilateral patchy opacities and diffuse alveolar haemorrhage was confirmed on bronchoscopy. Urgent dialysis was done and transfused with packed red blood cells. Renal biopsy was done and IgA deposition was seen and also mesangial proliferation was seen. The patient was successfully treated with intravenous methyl prednisone followed by oral prednisone. Post dialysis showed resolution of the bilateral infiltrates and Lab investigations after treatment with steroids and dialysis BUN 47, creatine & HB9, hematocrit 26. Discussion: Most cases of IgA nephropathy are idiopathic and are often diagnosed in its early stages. Its presenting symptoms are haematuria usually associated with an upper respiratory tract infection or less often gastroenteritis and is observed in 40-505 of presenting patients. IT is associated with a high mortality rate when IGAN presents with pulmonary haemorrhage and renal failure. Pulmonary haemorrhage with renal failure is referred for diagnosis such as Wegenerâ??s granulomatosis or Good pasture syndrome. Conclusion: This case presents one of the most uncommon clinical presentation of IgA nephropathy and early diagnosis and treatment of most common form of primary glomerulonephritis worldwide. This case presents an uncommon presentation of IgA nephropathy and patient was successfully treated.
