IgA Nephropathy Associated with ANCA Vasculitis: Case Report and Literature Review

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Elizabeth Torres Ruiz
Andrea Carolina Torres Ruiz
Rodolfo Martín Ruiz Ravelo
Norma Cecilia Ruiz Cruz
José de Jesús Fernández Rivera
Perla Karina Hernández De Lira

Abstract

IgA nephropathy is the most common primary glomerulonephritis, it’s association with Antineutrophil cytoplasmic antibody (ANCA) vasculitis constitutes a rare way of presentation that is scarcely described in the literature and diagnosed in only 1-2% of the population. The typical clinical presentation is an episode of systemic arterial hypertension with macroscopic hematuria,  non-nephrotic proteinuria, acute kidney injury and in the worst-cases if the disturb persists end-stage chronic kidney disease. The definitive diagnosis is made through a biopsy, which shows the main characteristics of this nephropathy, which consists in crescent-shaped glomeruli formation, fibrinoid necrosis, mesangial deposits of IgA, as well as positive ANCA antibodies. Treatment consists in systemic corticosteroids and immunosuppressants to prevent progression to end-stage renal disease. We present a case of a 55-year-old female patient with a history of upper respiratory tract infection 2 weeks prior to the development of macroscopic hematuria, foamy urine, non-nephrotic proteinuria, and persistent acute kidney injury in whom IgA nephropathy was determined, which had a successfully response to treatment with high doses of corticosteroids and systemic immunosuppressants.

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How to Cite
Torres Ruiz, E., Torres Ruiz, A. C., Ruiz Ravelo, R. M., Ruiz Cruz, N. C., Fernández Rivera, J. de J., & Hernández De Lira, P. K. (2023). IgA Nephropathy Associated with ANCA Vasculitis: Case Report and Literature Review. International Journal of Medical Science and Clinical Research Studies, 3(11), 2894–2899. https://doi.org/10.47191/ijmscrs/v3-i11-66
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References

I. Rojas-Rivera J, Fernández-Juárez G, Praga M. Rapidly progressive IgA nephropathy: a form of vasculitis or a complement-mediated disease? Clin Kidney J. 2015 Oct;8(5):477-81. doi: 10.1093/ckj/sfv095.

II. Wang X, Guo Z, Huang B, Xie M, Ren J, Zhu Y, Guo H, Wang Y, Yu D, Zhang J, Zhang L. IgA nephropathy with acute kidney disease: Characteristics, prognosis, and causes. Eur J Intern Med. 2022 Nov; 105:46-53. doi: 10.1016/j.ejim.2022.05.021.

III. Chebotareva N, Kamyshova E, Bulanov N, Lysenko L, Moiseev S, Antineutrophil cytoplasmic autoantibody (ANCA) positive immunoglobulin A (IgA) nephropathy: Case reports and review of literature. The Egyptian Rheumatologist. 2020 Jun; 42:251-254. doi 10.1016/j.ejr.2020.06.002.

IV. Yaseen K, Mandell BF. ANCA associated vasculitis (AAV): a review for internists. Postgrad Med. 2023 Jan;135(sup1):3-13. doi: 10.1080/00325481.2022.2102368.

V. Rajasekaran A, Julian BA, Rizk DV. IgA Nephropathy: An Interesting Autoimmune Kidney Disease. Am J Med Sci. 2021 Feb;361(2):176-194. doi: 10.1016/j.amjms.2020.10.003.

VI. Ștefan G, Terinte-Balcan G, Stancu S, Zugravu A, Gherghiceanu M, Mircescu G. IgA nephropathy with serum ANCA positivity: case series and literature review. Rheumatol Int. 2021 Jul;41(7):1347-1355. doi: 10.1007/s00296-021-04888-2.

VII. Yang YZ, Shi SF, Chen YQ, Chen M, Yang YH, Xie XF, Zou R, Lv JC, Liu LJ, Zhang H. Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case-control study. Clin Kidney J. 2015 Oct;8(5):482-8. doi: 10.1093/ckj/sfv078.

VIII. Hilhorst M, van Paassen P, Tervaert JW; Limburg Renal Registry. Proteinase 3-ANCA Vasculitis versus Myeloperoxidase-ANCA Vasculitis. J Am Soc Nephrol. 2015 Oct;26(10):2314-27. doi: 10.1681/ASN.2014090903.

IX. Rodrigues JC, Haas M, Reich HN. IgA Nephropathy. Clin J Am Soc Nephrol. 2017 Apr 3;12(4):677-686. doi: 10.2215/CJN.07420716.

X. Yates M, Watts R. ANCA-associated vasculitis. Clin Med (Lond). 2017 Feb;17(1):60-64. doi: 10.7861/clinmedicine.17-1-60.

XI. Yasukawa M, Kitagawa S, Togashi R, Asakawa S, Nagura M, Arai S, Yamazaki O, Tamura Y, Kondo F, Ohashi R, Uchida S, Shibata S, Fujigaki Y. A Patient with MPO-ANCA-positive IgA Nephropathy Diagnosed with the Clinical Onset of Macrohematuria. Intern Med. 2019 Jul 15;58(14):2051-2056. doi: 10.2169/internalmedicine.2475-18.

XII. Tota M, Donizy P, Byrska M, Krajewska M, Kusztal M. An unsuspected histopathological finding -concomitant IgA nephropathy in a patient with ANCA-associated vasculitis: a case report and literature review. Front Immunol. 2023 Aug 15;14:1227878. doi: 10.3389/fimmu.2023.1227878.

XIII. Agraz I, Castañeda Z, Sanz-Martínez MT, Gabaldón A, Bermejo S, Viñas Gimenez L, Bury R, Bolufer M, López-Martínez M, Ramos N, Bestard O, Soler MJ. The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment. J Clin Med. 2022 Nov 30;11(23):7122. doi: 10.3390/jcm11237122.

XIV. Xie L, He J, Liu X, Tang S, Wang W, Li F, Zhang Y, Zhang J, Huang Y, Zhao J, Li Y, Zhang J. Clinical value of systemic symptoms in IgA nephropathy with ANCA positivity. Clin Rheumatol. 2018 Jul;37(7):1953-1961. doi: 10.1007/s10067-017-3931-z.

XV. Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S, Flossmann O, Hall C, Hollywood J, Jayne D, Jones R, Lanyon P, Muir A, Scott D, Young L, Luqmani RA. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis. 2009 Dec;68(12):1827-32. doi: 10.1136/ard.2008.101279.

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