A Case of Arteriovenous Fistula after Renal Biopsy in an IgA Nephropathy Patient with Macroscopic Hematuria

Abstract Background and Aims Mesangial deposits Ig A was described the first time in 1968 by Berger and Hinglais. It remains the most common primary glomerulonephritis worldwide. It is often idiopathic but can also be secondary. The aim of our study is to describe the epidemiologic characteristics, the incidence and the anatomopathological features of 501 IgA nephropathy (IgA N) patients. Method It is a retrospective mono-centric study including patients having IgA N in the renal biopsy done in our department among a period of 17 years. Results We analyzed data of 8427 patients who underwent renal biopsy. 81% had glomerular nephropathy with 7.3% (501) IgA N. A male-to-female ratio of 2.27. The average age was 28.7 years. IgA N was primary in 80.2% cases and secondary in 17.8% cases. The most frequent secondary IgA N was rheumatoid purpura (74.8%). There was a male predominance in Berger‘s disease as well as in rheumatoid purpura. Berger’s disease was more common in adults, whereas rheumatoid purpura was more common in children. The main indication of renal biopsy was proteinuria with hematuria in 23.2% of cases and nephrotic syndrome in 23.8%. The association of non-nephrotic proteinuria, hematuria, arterial hypertension and renal injury was found in 9.3% whereas isolated macroscopic hematuria only in 6.4% of cases. According to HAAS classification, HAAS 3 was the most frequent. OXFORD classification used only from 2010, and M1, S1, E0, T0 and M1, S1, E0, T2 were the most frequent. Glomerular lesions were associated to tubulo interstitial and vascular lesions in 48.2% of cases. Conclusion IgA nephropathy is the most common glomerular disease and a frequent cause of end stage renal disease. Because of a clear increase of it’s incidence in our country and the delay in the diagnosis, a systematic screening of urines is needed in our country as it’s done in Singapore and Japan.

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Pattern of glomerular diseases in biopsy proven native kidney in Western Nepal

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v8i1.27998 ◽

2019 ◽

Vol 8 (1) ◽

pp. 5-8

Author(s):

Abhishek Maskey ◽

Lekhnath Lamsal

Keyword(s):

Renal Biopsy ◽

Iga Nephropathy ◽

Kidney Biopsy ◽

Kidney Diseases ◽

Genetic Diseases ◽

Safe Procedure ◽

Macroscopic Hematuria ◽

Glomerular Diseases ◽

Histological Pattern ◽

Perinephric Hematoma

Background and Aims: Kidney biopsy is decisive while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial and genetic diseases. There is paucity of data on prevalence and pattern of various types of kidney diseases in Nepalese population. We describe various types of kidney diseases in patient population undergoing kidney biopsy at our centre. Methods: This is a prospective analysis of all patients, who underwent percutaneous renal biopsy at Manipal teaching hospital, over a duration of 30 months, i.e. August 2017 to January 2019. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis. Results: A total of 175 consecutive biopsies were analyzed. The mean age of the patient was 35 } 15 years. Majority of the biopsy performed were in females. The majority of biopsy cases were age between 21-30 years of age. The youngest case to undergo renal biopsy was a child with asymptomatic isolated hematuria. The most frequent histological pattern observed in our study was IgA nephropathy (34.6%), followed by Focal segmental glomerulosclerosis (15.45%) and Membranous nephropathy (14.85%). Regarding complication macroscopic hematuria was seen in 15 (8.5%) cases and 8 (4.5%) cases had perinephric hematoma. There was no death related to renal biopsy. Conclusion: IgA nephropathy was the commonest histological pattern. Subnephrotic proteinuria was the commonest indication for biopsy. Complication of kidney biopsy is rare and considered safe procedure in clinical practice to determine diagnosis, prognosis and treatment.

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Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report

BMC Nephrology ◽

10.1186/s12882-021-02334-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shinya Taguchi ◽

Sumi Hidaka ◽

Mitsuru Yanai ◽

Kunihiro Ishioka ◽

Kenji Matsui ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Biopsy ◽

Prussian Blue ◽

Iga Nephropathy ◽

Acute Tubular Necrosis ◽

Immunoglobulin A ◽

Kidney Injury ◽

Upper Respiratory Tract ◽

Macroscopic Hematuria ◽

Tubular Necrosis

Abstract Background Macroscopic hematuria-associated acute kidney injury (AKI) is a well-known complication of immunoglobulin A (IgA) nephropathy. In such cases, intratubular obstruction by red blood cell (RBC) casts and acute tubular necrosis are mainly observed pathologically. Herein, we report the case of a patient with IgA nephropathy presenting with AKI following an episode of macrohematuria. The patient presented with severe renal tubular hemosiderosis and acute tubular necrosis and without any obvious obstructive RBC casts. Case presentation A 68-year-old woman, who was diagnosed with IgA nephropathy on renal biopsy 6 years ago, was admitted to our hospital after an episode of macroscopic glomerular hematuria and AKI following upper respiratory tract infection. Renal biopsy showed mesangial proliferation of the glomeruli, including crescent formation in 17 % of the glomeruli, and acute tubular necrosis without obvious hemorrhage or obstructive RBC casts. The application of Perls’ Prussian blue stain showed hemosiderin deposition in the renal proximal tubular cells. Immunofluorescence showed granular mesangial deposits of IgA and C3. Based on these findings, she was diagnosed with acute tubular necrosis with a concurrent IgA nephropathy flare-up. Moreover, direct tubular injury by heme and iron was considered to be the cause of AKI. She was treated with intravenous pulse methylprednisolone followed by oral prednisolone. Thereafter, the gross hematuria gradually faded, and her serum creatinine levels decreased. Conclusions IgA nephropathy presenting with acute kidney injury accompanied by macrohematuria may cause renal hemosiderosis and acute tubular necrosis without obstructive RBC casts. Hemosiderosis may be a useful indicator for determining the pathophysiology of macroscopic hematuria-associated AKI. However, renal hemosiderosis may remain undiagnosed. Thus, Perls’ Prussian blue iron staining should be more widely used in patients presenting with hematuria.

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Clinical and pathological findings of SARS-CoV-2 infection and concurrent IgA nephropathy: A case report

10.21203/rs.3.rs-35388/v1 ◽

2020 ◽

Author(s):

Liu Liu

Keyword(s):

Renal Biopsy ◽

Iga Nephropathy ◽

Case Reports ◽

Renal Involvement ◽

Glomerular Disease ◽

Angiotensin Ii Receptor Blocker ◽

Limited Data ◽

Angiotensin Ii Receptor ◽

Macroscopic Hematuria ◽

Renal Abnormalities

Abstract Background: Since the Coronavirus Disease 2019 (COVID-19) outbreak, there is limited data on the clinical characteristics, treatment strategies and prognosis of COVID-19 in patients with concurrent renal disease. The kidney is believed to have a predisposition for COVID-19 due to its abundant angiotensin-converting enzyme 2 (ACE2) expression, which acts as a cell entry receptor for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent postmortem investigations reveal renal involvement in COVID-19, and case reports describe collapsing glomerulopathy in African American patients with COVID-19. However, there is limited data regarding IgA nephropathy in the setting of COVID-19.Case presentation: In the present case, we report a 65-year old Chinese woman who presented with macroscopic hematuria, worsening proteinuria and decreased renal function after COVID-19 infection. She received a renal biopsy during COVID-19 infection. The renal biopsy revealed IgA nephropathy without any evidence for SARS-Cov-2. The findings suggest that the renal abnormalities were a consequence of exacerbation of this patient’s underlying glomerular disease after COVID-19 infection. After a regimen of 3-day course of glucocorticoid and angiotensin II receptor blocker therapy, the patient recovered and remained stable upon follow-up. Conclusions: It is important to consider the underlying glomerular disease exacerbation rather than virus induced injury when dealing with renal abnormalities in patients with COVID-19.

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Successful interventional treatment of arteriovenous fistula complicating percutaneous renal biopsy

VASA ◽

10.1024/0301-1526/a000261 ◽

2013 ◽

Vol 42 (2) ◽

pp. 149-152

Author(s):

Yun Xie ◽

Qin-Min Ge ◽

Fan Bian

Keyword(s):

Renal Biopsy ◽

Arteriovenous Fistula ◽

Interventional Treatment ◽

Percutaneous Renal Biopsy

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IgA Nephropathy: Association of a History of Macroscopic Hematuria Episodes with Increased Production of Polymeric IgA

Nephron ◽

10.1159/000184087 ◽

1987 ◽

Vol 45 (2) ◽

pp. 98-103 ◽

Cited By ~ 10

Author(s):

Luz Lozano ◽

Rosa García-Hoyo ◽

Jesús Egido

Keyword(s):

Iga Nephropathy ◽

Macroscopic Hematuria ◽

History Of

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Tonsillectomy in IgA Nephropathy - Clinical Case

Acta Medica Transilvanica ◽

10.2478/amtsb-2021-0053 ◽

2021 ◽

Vol 26 (3) ◽

pp. 59-61

Author(s):

Livia Mirela Popa ◽

Livia Popa ◽

Cătălin-Bogdan Osalciuc

Keyword(s):

Antibiotic Therapy ◽

Iga Nephropathy ◽

Clinical Case ◽

Acute Infection ◽

Acute Onset ◽

First Episode ◽

Urinary Volume ◽

Upper Airways ◽

Macroscopic Hematuria ◽

Nephritic Syndrome

Abstract This article presents the clinical case of IgA nephropathy of a patient hospitalized in order to investigate a nephritic syndrome, apparently with acute onset, discovered in the following circumstances: recurrent macroscopic hematuria, decreased urinary volume, the first episode occurring about a month ago in the context of an acute infection of upper airways, remitted under antibiotic therapy, with reappearance every 2 weeks, also accompanied by odynophagia and decreased urinary volume.

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Indian scenario of IgA nephropathy: a systematic review and meta-analysis

African Health Sciences ◽

10.4314/ahs.v21i1.21 ◽

2021 ◽

Vol 21 (1) ◽

pp. 159-65

Author(s):

Anju Khairwa

Keyword(s):

Systematic Review ◽

Iga Nephropathy ◽

Clinical Features ◽

Meta Analysis ◽

Microscopic Hematuria ◽

Macroscopic Hematuria ◽

Female Ratio ◽

Cochrane Database ◽

Male Female Ratio ◽

Indian Scenario

Background: IgA nephropathy (IgAN) is most common primary glomerulopathy. There are variations in prevalence of IgAN and its clinical features in different studies from India. Aim: To summarize overall scenario of IgAN in India. Methods: In this systematic review, studies related to IgAN and related renal disease were included. Data searched were PubMed, EMBASE, Google scholar, and Cochrane Database from inception to 31st January 2019. Results: Total 49 studies (N=2480) were included: 21studies (N=2309) of primary IgAN; 19 studies (N=21) of Secondary IgAN; four studies (N=133) of IgA vasculitis nephropathy (IgAVN); and five studies (N=17) of IgA dominant nephropathy (IgADN). Prevalence of IgAN was 16.5% in India. Age of affected persons was ranging from 27.2±16.7 to 48.6±21.3 years . Male female ratio was 1.8:1. Clinical features of Primary IgAN, IgAVN, IgADN & Secondary IgAN were microscopic hematuria (49.6%, 44.4%, 15.6% & 59.5%), macroscopic hematuria (5.1%, 0.4%,40.9%,& 35.7%), Subnephrotic proteinuria (42.1%, 29.4%, 23.2%, & 52.3%), nephrotic proteinuria (16.0%, 4.4%, 76.8%,& 47.6%), and hypertension (25.8%,18.3%, 35.5%,& 47.6%).. The 24 hours proteinuria was ranging from 2.6±1.5 to 4.7±2.3 gm/day and serum creatinine (mg/dl) was ranging from 0.9±0 to 3.5±3.9 mg/dl. Histolomorphologically, all type of IgAN showed mesangial hypercellularity and Immunofluorescence revealed IgA deposition. Conclusion: The overall prevalence of primary IgAN in India was 16.5%. The subnephrotic proteinuria and microscopic hematuria were common clinical features. Keywords: IgA Nephropathy; histomorphology; prevalence; India.

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