SECONDARY HYPERTENSION AND ACUTE KIDNEY INJURY IN IGA NEPHROPATHY: A CASE REPORT

Document Type

Conference Proceeding

Publication Date

7-17-2025

Publication Title

J Gen Intern Med

Keywords

Health Care Sciences & Services, General & Internal Medicine

Abstract

CASE: A 24-year-old female presented with a two-year history of worsening hypertension. Elevated BP was first noted in May 2023 (134/91 mmHg), but no follow-up was pursued. Elevated BP was noted again in May 2024 (134/91 mmHg) and was attributed to stress. Laboratory evaluation revealed declining renal function (Cr 1.45 mg/dL, GFR 51 mL/min/1.73 m2, albumin 3.2 g/dL), attributed to dehydration. By September 2024, home BP readings ranged from 140/90 to 160/110 mmHg. Two months later, she had a BP of 188/124 mmHg at a PCP appointment. Labs showed significant renal dysfunction (BUN 36 mg/dL, Cr 3.64 mg/dL, GFR 17 mL/min/1.73 m2) and proteinuria (>300 mg/dL). Her PCP advised immediate emergency department evaluation for acute renal failure. In the ER, her BP measured 193/136 mmHg. Ultrasound revealed echogenic kidneys with left kidney enlargement. Despite the findings, she appeared euvolemic and well. Workup demonstrated nephrotic syndrome with marked proteinuria (>300 mg/dL), albumin/Cr ratio of 3517–5000 mg/g, hyperlipidemia (cholesterol 274 mg/dL, triglycerides 262 mg/dL), and hypoalbuminemia (3.2 g/dL). PT/PTT were normal. Kidney biopsy revealed mesangial expansion, glomerular sclerosis, interstitial fibrosis, and crescents. Immunofluorescence confirmed IgA deposition, while electron microscopy showed mesangial electron-dense deposits and foot process effacement. These findings were consistent with IgA nephropathy. The patient was discharged on labetalol, nifedipine, and losartan, with plans for close follow-up with primary care and transplant nephrology. Her past medical history was notable only for headaches and urinary tract infections. She denied alcohol, tobacco, or drug use. Relevant family history included hypertension in her father. IMPACT/DISCUSSION: Nephrotic syndrome typically presents with proteinuria, hypoalbuminemia, hyperlipidemia, and edema. However, this patient's lack of edema despite hypoalbuminemia and hyperlipidemia underscores the variability in clinical presentation. IgA nephropathy, characterized by IgA deposits in the glomeruli, often presents with gross hematuria in children but may manifest more subtly in adults. Early signs, such as microscopic hematuria and proteinuria, can be easily overlooked without routine screening. While hypertension is commonly associated with the condition, it is a nonspecific finding. The investigation of abnormal blood pressure alongside consistent urinalysis monitoring is critical for the timely detection of IgA nephropathy. This is important as persistent proteinuria and hematuria are key indicators of disease progression. Early diagnosis and intervention are crucial, given that up to 50% of patients with IgA nephropathy progress to end-stage renal disease within three decades. CONCLUSION: Early intervention is critical in mitigating renal dysfunction progression in young patients with secondary hypertension. Secondary hypertension must be accompanied with comprehensive evaluation even in patients without typical risk factors.

Volume

40

First Page

S54

Find It @ Sladen

Share

COinS