J Nephropathol. 2019;8(3): e29.
doi: 10.15171/jnp.2019.29
  Abstract View: 355
  PDF Download: 154

Case Report

IgA nephropathy presenting with pulmonary thromboembolism and renal artery infarct

Madhav Venkatesan 1 * ORCiD, Anil Mathew 1, Rajesh Nair 1, George Kurian 1, Seethalekshmy NV 2, Sandeep Sreedharan 1 * , Zachariah Paul 1

1 Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, India
2 Department of Pathology, Amrita Institute of Medical Sciences, Kochi, India
*Corresponding author: Sandeep Sreedharan, Email: Email: sandcho@gmail.com

Abstract

Background: Venous and arterial thromboembolism are frequently seen in nephrotic syndrome. They generally occur during periods of sustained proteinuria in patients who are not responding to treatment and more commonly seen in minimal change disease and membranous nephropathy.

Case Presentation: A 28-year-old male presented to cardiology department of our hospital with worsening breathlessness for 1 week. We found pulmonary embolism and an infarct in the lower pole of the right kidney by CT pulmonary angiogram. He had no previous history or features of nephrotic syndrome. Urine analysis showed numerous red blood cells, 3+ proteinuria and granular casts. Urine protein creatinine ratio was 5.2 g/g of creatinine. Serum creatinine was 2.61 mg/dL. Renal biopsy was suggestive of IgA nephropathy and patient was started on steroids and warfarin and responded to treatment.

Conclusions: Patients with nephrotic syndrome can rarely present initially with venous and arterial thromboembolism. Rarely even IgA nephropathy can present with such thromboembolic episodes.

Implication for health policy/practice/research/medical education:

Arterial and venous thrombosis commonly occurs after a prolonged period of nephrotic syndrome and hypoalbuminemia. In some rare cases, the initial presentation can itself just be arterial/venous thrombosis. Hence we should search for nephrotic syndrome in patients with thrombotic episodes. Though it is more commonly seen in minimal change disease, it can also be seen in IgA nephropathy.

Please cite this paper as: Venkatesan M, Mathew A, Nair R, Kurian G, NV S, Sreedharan S, Paul Z. IgA nephropathy presenting with pulmonary thromboembolism and renal artery infarct. J Nephropathol. 2019;8(3):e29. DOI: 10.15171/jnp.2019.29.

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Submitted: 07 Apr 2018
Accepted: 10 Jul 2018
First published online: 14 Aug 2018
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