Rapidly progressive renal failure as the onset of an IgA nephropathy in an elderly patient
Insuficiencia renal rápidamente progresiva como comienzo de una nefropatía IgA en un anciano
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"apellidos" => "SÁNCHEZ" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "Iniciales" => "F." "apellidos" => "ÁLVAREZ-UDE" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General, Segovia, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Ramón y Cajal, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General, Segovia, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Insuficiencia renal rápidamente progresiva como comienzo de una nefropatía IgA en un anciano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10661_108_15835_en_10661_f1.jpg" "Alto" => 451 "Ancho" => 600 "Tamanyo" => 222212 ] ] "descripcion" => array:1 [ "en" => "Haematoxylin and eosin (20x) with two glomeruli with intense diffuse proliferation of the capillaries." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">IgA nephropathy is the most frequent primary glomerulopathy in the world.<span class="elsevierStyleSup">1,2</span> It is often presented as macroscopic haematuria (generally preceded by a respiratory infection in the upper airways, especially in children), and persistent microhaematuria with mild proteinuria. Nephrotic syndrome and acute renal failure are the least common manifestations. We describe the case of an elderly patient that was diagnosed with IgA nephropathy, as a result of rapidly progressive renal failure (RPRF).</p><p class="elsevierStylePara">The patient was a 78-year-old man with a history of prostate carcinoma, treated with brachytherapy and radiotherapy check-ups every 6 months; carpal tunnel syndrome; right hip operation; and no known drug allergies.</p><p class="elsevierStylePara">His doctor had referred him to the emergency department due to tiredness and pain in his lower limbs. The patient’s medical records indicated that he had suffered from nocturia on two occasions. The physical examination performed upon admission indicated that the patient’s general condition was fair. He was conscious and aware of his surroundings. He did not have jugular ingurgitation. Blood pressure was 135/85mm Hg, heart rate was 82 beats/min and SatO<span class="elsevierStyleInf">2</span>:<span class="elsevierStyleInf"> </span>92%. The heart auscultation was rhythmic and pulmonary auscultation presented hypoventilation with isolated wheezing. The rest of the examination was normal.</p><p class="elsevierStylePara">The blood analysis (emergency department) was: creatinine: 2.9mg/dl (previous creatinine: 1.2mg/dl); potassium: 5.3mEq/l; haemoglobin: 11.5g/dl; haematocrit: 34.7%; remaining analyses, including venous gasometry and the coagulation test, were normal.</p><p class="elsevierStylePara">Systematic urine analysis showed: protein +++, blood ++. The sediment test showed haematuria, with isolated hyaline casts.</p><p class="elsevierStylePara">Chest X-ray and abdominal ultrasound did not show any pathological findings, the kidneys were of normal size, and the excretory tract was not dilated.</p><p class="elsevierStylePara">The subsequent blood analysis (common) showed: creatinine: 3.9mg/dl; urea: 181mg/dl; albumin: 2.7g/dl; total protein: 5g/dl; calcium: 6.9mg/dl; phosphorus: 8.1mg/dl; uric acid: 8.3mg/dl; sodium: 132mEq/l. 24-hour urine test found microalbuminuria, which was 620µg/min (normal range: 0-15µg/min). Other supplementary tests performed were normal (including viral serology, blood culture, tumour markers and thyroid hormones). The immunological test only showed a decrease in IgG of 574mg/dl (normal value: 751-1560) and an increase in C-reactive protein to 8.7mg/dl. No monoclonal peak was detected on the electropherogram.</p><p class="elsevierStylePara">The patient had been admitted to the internal medicine department, where progressive deterioration of the renal failure and oligoanuria were confirmed. Renal replacement therapy with haemodialysis was started. Given the rapidly progressive acute renal failure, a kidney biopsy was performed, finding the following: 12 glomeruli per cross-section, none of which was sclerotic. We observed an expansion of the mesangial matrix with cellular proliferation in all of the glomeruli examined. On occasions, they affected the whole glomerulus, with pseudo-lobe images of the vascular tuft. There were fibrinoid necrosis foci in three glomeruli. The immunofluorescence showed intense positivity for IgA and C3, being negative for IgG and IgM. All the alterations found pointed to mild acute tubular necrosis with mixed inflammatory infiltration. The final diagnosis was IgA nephropathy with diffuse proliferation and fibrinoid necrosis foci (Figures 1 and 2).</p><p class="elsevierStylePara">As well as the support therapy with furosemide, enalapril was administered at 40mg/day, irbesartan 150mg/day and doxazosin 8mg/day. The biopsy findings lead to administration of three pulses i.v. of 1g of 6-methylprednisolone followed by prednisone at a dose of 1mg/kg/day. Diuresis was recovered with these measures, and kidney function gradually improved without the need for dialysis (creatinine reduced from 5.4mg/dl to 2mg/dl upon hospital discharge). Table 1 shows the follow-up and progress following hospital discharge.</p><p class="elsevierStylePara">There are mild forms of IgA nephropathy that can go unnoticed. In fact, in some autopsy and biopsy studies conducted to assess renal grafts, IgA nephropathy can be found in around 1.5% of the normal population.<span class="elsevierStyleSup">3</span> We describe the case of an elderly patient, who had no previous nephrology problems, who was diagnosed with IgA nephropathy following a kidney biopsy to confirm the cause of RPRF.</p><p class="elsevierStylePara">IgA nephropathy can appear at any age, but most frequently during the second and third decades of the life.<span class="elsevierStyleSup">4</span> It is possible that the prevalence in the elderly population is higher than has been described in the literature, possibly due to kidney biopsy indication. Persistent urinary alterations may attribute to other concomitant disorders (prostatitis, infections, etc.) and if a kidney biopsy is not performed, IgA nephropathy may be underdiagnosed.<span class="elsevierStyleSup">5</span> Given our patient’s history of prostate carcinoma, this nephropathy could have gone unnoticed if it had not been for obvious manifestations of acute renal failure.</p><p class="elsevierStylePara">Although this nephropathy is the most frequent one, an optimum treatment has not been well-established.<span class="elsevierStyleSup">6</span> Based on a review of 20 years experience, a third of these patients can develop end-stage chronic kidney disease (ECKD).<span class="elsevierStyleSup">7</span> Two studies have recently been published which have shown the benefits of co-administering corticoids (short-term) and angiotensin-converting enzymes (ACE) to treat IgA nephropathy with moderated histological lesions, with proteinuria above 1g/day.<span class="elsevierStyleSup">8,9 </span>Combined immunosuppressant therapy is indicated in patients with rapidly progressive active severe disease and with histological evidence of active severe inflammation (crescents).<span class="elsevierStyleSup">10</span> In our case, we treated a patient with a history of rapidly progressive prostate cancer, with diffuse proliferation and fibrinoid necrosis foci and with no chronicity data. We decided to treat the patient with i.v. pulsed steroids followed by oral steroids with ACE and angiotensin II receptor antagonists. The patient progressed satisfactorily.</p><p class="elsevierStylePara">In summary, we have reported one more IgA case in an elderly patient, which probably would have gone unnoticed if the aggressive clinical symptoms had not started.</p><p class="elsevierStylePara"><a href="grande/10661_108_15835_en_10661_f1.jpg" class="elsevierStyleCrossRefs"><img src="10661_108_15835_en_10661_f1.jpg" alt="Haematoxylin and eosin (20x) with two glomeruli with intense diffuse proliferation of the capillaries."></img></a></p><p class="elsevierStylePara">Figure 1. Haematoxylin and eosin (20x) with two glomeruli with intense diffuse proliferation of the capillaries.</p><p class="elsevierStylePara"><a href="grande/10661_108_15836_en_10661_f2.jpg" class="elsevierStyleCrossRefs"><img src="10661_108_15836_en_10661_f2.jpg" alt="Haematoxylin and eosin (40x) with one glomerulus with intense diffuse proliferation and fibrinoid necrosis foci."></img></a></p><p class="elsevierStylePara">Figure 2. Haematoxylin and eosin (40x) with one glomerulus with intense diffuse proliferation and fibrinoid necrosis foci.</p><p class="elsevierStylePara"><a href="grande/10661_16025_15868_en_t5.jpg" class="elsevierStyleCrossRefs"><img src="10661_16025_15868_en_t5.jpg" alt="12-month clinical follow-up following hospital discharge"></img></a></p><p class="elsevierStylePara">Table 1. 12-month clinical follow-up following hospital discharge</p>" "pdfFichero" => "P1-E518-S2912-A10661-EN.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10661_108_15835_en_10661_f1.jpg" "Alto" => 451 "Ancho" => 600 "Tamanyo" => 222212 ] ] "descripcion" => array:1 [ "en" => "Haematoxylin and eosin (20x) with two glomeruli with intense diffuse proliferation of the capillaries." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10661_108_15836_en_10661_f2.jpg" "Alto" => 451 "Ancho" => 600 "Tamanyo" => 228352 ] ] "descripcion" => array:1 [ "en" => "Haematoxylin and eosin (40x) with one glomerulus with intense diffuse proliferation and fibrinoid necrosis foci." ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10661_16025_15868_en_t5.jpg" "Alto" => 292 "Ancho" => 600 "Tamanyo" => 117164 ] ] "descripcion" => array:1 [ "en" => "12-month clinical follow-up following hospital discharge" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Galla JH. IgA nephropathy. Kidney Int 1995;47(2):377-87. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7723227" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Donadio JV, Grande JP. IgA nephropathy. N Engl J Med 2002;347(10):738-48. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12213946" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Suzuki K, Honda K, Tanabe K, Nihei H, Yamaguchi Y. Incidence of latent mesangial IgA deposition in renal allograft donors in Japan. Kidney Int 2003;63:2286-94. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12753320" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Clarkson AR, Woodroffe AJ, Bannister KM, Lomax-Smith JD, Aarons I. The syndrome of IgA nephropathy. Clin Nephrol 1984;21:7-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6231147" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Heras M, Saiz A, Sánchez R, Fernández-Reyes MJ, Molina A, Rodríguez MA, Aet al.\u{A0}La biopsia renal en pacientes de 65 o más años: ¿existen diferencias en la indicación y en la histopatología respecto al resto de pacientes?. Rev Esp Geriat Gerontol 2010;45(6):316-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Appel GB, Waldman M. The IgA nephropathy treatment dilemma.\u{A0}Kidney Int 2006;69(11):1939-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16641925" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "D´Amico G. Natural history of idiopathic IgA nephropathy: role of clinical and histological prognostic factors. Am J Kidney Dis 2000;36:227-37. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10922300" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Manno C, Torres DD, Rossini M, Pesce F, Schena FP. Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy. Nephrol Dial Transpl 2009;24:3694-701." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lu J, Zhang H, Chen Y, Li G, Jiang L, Singh AK, Wang H. Combination therapy of prednisone and ACE inhibitors versus ACE-inhibitors alone in patients with IgAnephopathy: a randomized controlled trial. Am J Kidney Dis 2009;53(1):26-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18930568" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ballardie FW, Roberts IS. Controlled prospective trial of prednisolone and cytotoxics in progressive IgA nephropathy. JASN 2002;13(1):142-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11752031" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051504/v0_201502091641/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000002/v0_201502091641/X2013251411051504/v0_201502091641/en/P1-E518-S2912-A10661-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051504?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 4 | 10 |
| 2024 October | 72 | 27 | 99 |
| 2024 September | 69 | 21 | 90 |
| 2024 August | 84 | 51 | 135 |
| 2024 July | 61 | 37 | 98 |
| 2024 June | 78 | 35 | 113 |
| 2024 May | 72 | 31 | 103 |
| 2024 April | 70 | 40 | 110 |
| 2024 March | 53 | 29 | 82 |
| 2024 February | 49 | 276 | 325 |
| 2024 January | 45 | 34 | 79 |
| 2023 December | 41 | 46 | 87 |
| 2023 November | 56 | 33 | 89 |
| 2023 October | 75 | 63 | 138 |
| 2023 September | 63 | 46 | 109 |
| 2023 August | 47 | 20 | 67 |
| 2023 July | 77 | 39 | 116 |
| 2023 June | 76 | 27 | 103 |
| 2023 May | 103 | 38 | 141 |
| 2023 April | 68 | 32 | 100 |
| 2023 March | 66 | 16 | 82 |
| 2023 February | 76 | 38 | 114 |
| 2023 January | 64 | 36 | 100 |
| 2022 December | 57 | 47 | 104 |
| 2022 November | 57 | 32 | 89 |
| 2022 October | 68 | 43 | 111 |
| 2022 September | 61 | 36 | 97 |
| 2022 August | 80 | 55 | 135 |
| 2022 July | 62 | 40 | 102 |
| 2022 June | 57 | 36 | 93 |
| 2022 May | 103 | 49 | 152 |
| 2022 April | 91 | 57 | 148 |
| 2022 March | 73 | 41 | 114 |
| 2022 February | 108 | 51 | 159 |
| 2022 January | 70 | 36 | 106 |
| 2021 December | 90 | 45 | 135 |
| 2021 November | 91 | 45 | 136 |
| 2021 October | 79 | 52 | 131 |
| 2021 September | 75 | 38 | 113 |
| 2021 August | 62 | 37 | 99 |
| 2021 July | 61 | 50 | 111 |
| 2021 June | 39 | 29 | 68 |
| 2021 May | 74 | 49 | 123 |
| 2021 April | 190 | 63 | 253 |
| 2021 March | 57 | 46 | 103 |
| 2021 February | 83 | 20 | 103 |
| 2021 January | 46 | 25 | 71 |
| 2020 December | 38 | 13 | 51 |
| 2020 November | 27 | 11 | 38 |
| 2020 October | 26 | 25 | 51 |
| 2020 September | 25 | 10 | 35 |
| 2020 August | 44 | 9 | 53 |
| 2020 July | 45 | 4 | 49 |
| 2020 June | 42 | 11 | 53 |
| 2020 May | 41 | 16 | 57 |
| 2020 April | 44 | 19 | 63 |
| 2020 March | 54 | 8 | 62 |
| 2020 February | 71 | 18 | 89 |
| 2020 January | 84 | 21 | 105 |
| 2019 December | 87 | 30 | 117 |
| 2019 November | 57 | 16 | 73 |
| 2019 October | 33 | 12 | 45 |
| 2019 September | 47 | 17 | 64 |
| 2019 August | 41 | 13 | 54 |
| 2019 July | 52 | 18 | 70 |
| 2019 June | 45 | 11 | 56 |
| 2019 May | 58 | 13 | 71 |
| 2019 April | 75 | 34 | 109 |
| 2019 March | 42 | 20 | 62 |
| 2019 February | 33 | 20 | 53 |
| 2019 January | 44 | 15 | 59 |
| 2018 December | 90 | 40 | 130 |
| 2018 November | 134 | 19 | 153 |
| 2018 October | 185 | 26 | 211 |
| 2018 September | 78 | 13 | 91 |
| 2018 August | 70 | 6 | 76 |
| 2018 July | 46 | 14 | 60 |
| 2018 June | 55 | 6 | 61 |
| 2018 May | 52 | 12 | 64 |
| 2018 April | 68 | 9 | 77 |
| 2018 March | 65 | 7 | 72 |
| 2018 February | 62 | 9 | 71 |
| 2018 January | 56 | 6 | 62 |
| 2017 December | 68 | 10 | 78 |
| 2017 November | 48 | 26 | 74 |
| 2017 October | 44 | 8 | 52 |
| 2017 September | 61 | 18 | 79 |
| 2017 August | 47 | 16 | 63 |
| 2017 July | 42 | 23 | 65 |
| 2017 June | 72 | 13 | 85 |
| 2017 May | 61 | 11 | 72 |
| 2017 April | 68 | 15 | 83 |
| 2017 March | 40 | 7 | 47 |
| 2017 February | 44 | 8 | 52 |
| 2017 January | 52 | 7 | 59 |
| 2016 December | 70 | 12 | 82 |
| 2016 November | 79 | 10 | 89 |
| 2016 October | 138 | 15 | 153 |
| 2016 September | 145 | 1 | 146 |
| 2016 August | 215 | 7 | 222 |
| 2016 July | 172 | 12 | 184 |
| 2016 June | 164 | 0 | 164 |
| 2016 May | 127 | 0 | 127 |
| 2016 April | 117 | 0 | 117 |
| 2016 March | 93 | 0 | 93 |
| 2016 February | 136 | 0 | 136 |
| 2016 January | 130 | 0 | 130 |
| 2015 December | 118 | 0 | 118 |
| 2015 November | 91 | 0 | 91 |
| 2015 October | 94 | 0 | 94 |
| 2015 September | 79 | 0 | 79 |
| 2015 August | 70 | 0 | 70 |
| 2015 July | 75 | 0 | 75 |
| 2015 June | 32 | 0 | 32 |
| 2015 May | 43 | 0 | 43 |
| 2015 April | 5 | 0 | 5 |
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