To preserve patient privacy and for didactic purposes, case descriptions and pathology reports have been anonymized and partially fictionalized. The pathology images are representative images from a mixture of similar cases.
Johannes Schlondorff Case Presenter | Beth Israel Deaconess Medical Center, Boston, MA, USA | Conflict of interest reported: Partners Healthcare/BWH – Patent/IP
Mihran NaljayanNephrology Discussant | Louisiana State University Health Sciences Center, New Orleans, LA, USA | No conflict of interest reported
Patient is a 30-year-old female found to have microscopic hematuria and proteinuria at approximately 12 weeks of gestation. Findings were noted at her routine obstetric evaluation.
Medical history: G1P0
Medications: Prenatal vitamins
Physical Exam: Borderline hypertension at initial visit.
Laboratory and other data: Serum creatinine 0.7 mg/dl. Hypoalbuminemia (3.1-3.4 g/dl), total cholesterol 250 mg/dl, not full nephrotic syndrome. Serologies negative. Urinary protein to creatinine ratio 4.3 g/g (UA 8 years ago was negative, now lg blood and lg protein)
Pathology images pending
IgA nephropathy, segmental sclerosis pattern.
Less than 15% of glomeruli are globally sclerotic.
No endo- or extra-capillary proliferation or segmental necrosis is seen. There is mild interstitial fibrosis and tubular atrophy. Mild chronic inflammation accompanies the scarring.
Immunofluorescence: There is granular mesangial and some peripheral capillary loop staining for IgA (2-3+), IgM (trace), C3 (1-2+), fibrin (trace), kappa (1-2+), and lambda (1+). 1+ C3 is seen along tubular basement membranes and in vessels. IgG, C1q and albumin are negative.
Questions posed & summary of key discussion points
1. How would you treat this? Specifically, would you use immunosuppression? 2. When would you anticoagulate? Would you consider prophylactic ASA given some data that it reduces risk of preeclampsia?
Author(s) of case summary:
Case summary pending
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