Today for conference we discussed a case of a young patient presenting with SOB and hemoptysis. On initial labs found to have creatinine of 14. We discussed pulmonary-renal syndromes (and other reasons for a young patient with kidney disease to present with respiratory failure). Subsequent evaluation after normal complement, ANCA and GBM included renal biopsy which showed IgA nephropathy. More information on the slides IgAN – 1.13 and on this review article from NEJM nejmra1206793.
Take home points:
- It is important to develop a systematic approach to diagnosing AKI
- Distinguish Nephrotic from Nephritic syndrome through urinalysis/microscopy (proteinuria, hematuria, casts)
- Navigate nephritic syndromes with a simple schema starting with complement levels +/- ANCA and Anti-GBM
- IgAN usually presents as synpharingitic intermittent hematuria, or asymptomatic hematuria. Less often it presents acutely with AKI
- Treatment of IgAN is usually with general measures (ACEi). The role of immunosuppression is not well proven