Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report

Abstract Background Macroscopic hematuria-associated acute kidney injury (AKI) is a well-known complication of immunoglobulin A (IgA) nephropathy. In such cases, intratubular obstruction by red blood cell (RBC) casts and acute tubular necrosis are mainly observed pathologically. Herein, we report th...

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Main Authors: Shinya Taguchi, Sumi Hidaka, Mitsuru Yanai, Kunihiro Ishioka, Kenji Matsui, Yasuhiro Mochida, Hidekazu Moriya, Takayasu Ohtake, Shuzo Kobayashi
Format: Article
Language:English
Published: BMC 2021-04-01
Series:BMC Nephrology
Subjects:
Online Access:https://doi.org/10.1186/s12882-021-02334-w
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spelling doaj-bad02b26f30c4b4cb8184d9fb3db95d62021-04-18T11:47:55ZengBMCBMC Nephrology1471-23692021-04-012211610.1186/s12882-021-02334-wRenal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case reportShinya Taguchi0Sumi Hidaka1Mitsuru Yanai2Kunihiro Ishioka3Kenji Matsui4Yasuhiro Mochida5Hidekazu Moriya6Takayasu Ohtake7Shuzo Kobayashi8Kidney Disease and Transplant Center, Shonan Kamakura General HospitalKidney Disease and Transplant Center, Shonan Kamakura General HospitalDepartment of Pathology, Sapporo Tokushukai HospitalKidney Disease and Transplant Center, Shonan Kamakura General HospitalKidney Disease and Transplant Center, Shonan Kamakura General HospitalKidney Disease and Transplant Center, Shonan Kamakura General HospitalKidney Disease and Transplant Center, Shonan Kamakura General HospitalKidney Disease and Transplant Center, Shonan Kamakura General HospitalKidney Disease and Transplant Center, Shonan Kamakura General HospitalAbstract Background Macroscopic hematuria-associated acute kidney injury (AKI) is a well-known complication of immunoglobulin A (IgA) nephropathy. In such cases, intratubular obstruction by red blood cell (RBC) casts and acute tubular necrosis are mainly observed pathologically. Herein, we report the case of a patient with IgA nephropathy presenting with AKI following an episode of macrohematuria. The patient presented with severe renal tubular hemosiderosis and acute tubular necrosis and without any obvious obstructive RBC casts. Case presentation A 68-year-old woman, who was diagnosed with IgA nephropathy on renal biopsy 6 years ago, was admitted to our hospital after an episode of macroscopic glomerular hematuria and AKI following upper respiratory tract infection. Renal biopsy showed mesangial proliferation of the glomeruli, including crescent formation in 17 % of the glomeruli, and acute tubular necrosis without obvious hemorrhage or obstructive RBC casts. The application of Perls’ Prussian blue stain showed hemosiderin deposition in the renal proximal tubular cells. Immunofluorescence showed granular mesangial deposits of IgA and C3. Based on these findings, she was diagnosed with acute tubular necrosis with a concurrent IgA nephropathy flare-up. Moreover, direct tubular injury by heme and iron was considered to be the cause of AKI. She was treated with intravenous pulse methylprednisolone followed by oral prednisolone. Thereafter, the gross hematuria gradually faded, and her serum creatinine levels decreased. Conclusions IgA nephropathy presenting with acute kidney injury accompanied by macrohematuria may cause renal hemosiderosis and acute tubular necrosis without obstructive RBC casts. Hemosiderosis may be a useful indicator for determining the pathophysiology of macroscopic hematuria-associated AKI. However, renal hemosiderosis may remain undiagnosed. Thus, Perls’ Prussian blue iron staining should be more widely used in patients presenting with hematuria.https://doi.org/10.1186/s12882-021-02334-wIgA nephropathyMacroscopic hematuriaMacrohematuriaImmunoglobulin AHemosiderinHemosiderosis
collection DOAJ
language English
format Article
sources DOAJ
author Shinya Taguchi
Sumi Hidaka
Mitsuru Yanai
Kunihiro Ishioka
Kenji Matsui
Yasuhiro Mochida
Hidekazu Moriya
Takayasu Ohtake
Shuzo Kobayashi
spellingShingle Shinya Taguchi
Sumi Hidaka
Mitsuru Yanai
Kunihiro Ishioka
Kenji Matsui
Yasuhiro Mochida
Hidekazu Moriya
Takayasu Ohtake
Shuzo Kobayashi
Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report
BMC Nephrology
IgA nephropathy
Macroscopic hematuria
Macrohematuria
Immunoglobulin A
Hemosiderin
Hemosiderosis
author_facet Shinya Taguchi
Sumi Hidaka
Mitsuru Yanai
Kunihiro Ishioka
Kenji Matsui
Yasuhiro Mochida
Hidekazu Moriya
Takayasu Ohtake
Shuzo Kobayashi
author_sort Shinya Taguchi
title Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report
title_short Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report
title_full Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report
title_fullStr Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report
title_full_unstemmed Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report
title_sort renal hemosiderosis presenting with acute kidney injury and macroscopic hematuria in immunoglobulin a nephropathy: a case report
publisher BMC
series BMC Nephrology
issn 1471-2369
publishDate 2021-04-01
description Abstract Background Macroscopic hematuria-associated acute kidney injury (AKI) is a well-known complication of immunoglobulin A (IgA) nephropathy. In such cases, intratubular obstruction by red blood cell (RBC) casts and acute tubular necrosis are mainly observed pathologically. Herein, we report the case of a patient with IgA nephropathy presenting with AKI following an episode of macrohematuria. The patient presented with severe renal tubular hemosiderosis and acute tubular necrosis and without any obvious obstructive RBC casts. Case presentation A 68-year-old woman, who was diagnosed with IgA nephropathy on renal biopsy 6 years ago, was admitted to our hospital after an episode of macroscopic glomerular hematuria and AKI following upper respiratory tract infection. Renal biopsy showed mesangial proliferation of the glomeruli, including crescent formation in 17 % of the glomeruli, and acute tubular necrosis without obvious hemorrhage or obstructive RBC casts. The application of Perls’ Prussian blue stain showed hemosiderin deposition in the renal proximal tubular cells. Immunofluorescence showed granular mesangial deposits of IgA and C3. Based on these findings, she was diagnosed with acute tubular necrosis with a concurrent IgA nephropathy flare-up. Moreover, direct tubular injury by heme and iron was considered to be the cause of AKI. She was treated with intravenous pulse methylprednisolone followed by oral prednisolone. Thereafter, the gross hematuria gradually faded, and her serum creatinine levels decreased. Conclusions IgA nephropathy presenting with acute kidney injury accompanied by macrohematuria may cause renal hemosiderosis and acute tubular necrosis without obstructive RBC casts. Hemosiderosis may be a useful indicator for determining the pathophysiology of macroscopic hematuria-associated AKI. However, renal hemosiderosis may remain undiagnosed. Thus, Perls’ Prussian blue iron staining should be more widely used in patients presenting with hematuria.
topic IgA nephropathy
Macroscopic hematuria
Macrohematuria
Immunoglobulin A
Hemosiderin
Hemosiderosis
url https://doi.org/10.1186/s12882-021-02334-w
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