M PUSPITASARI1,2, H RINONCE1,2, D MULYA1,2, I KUSWADI1,2, H PRASANTO1,2
1Sardjito Hospital Yogyakarta Indonesia, Sleman, Yogyakarta, Indonesia, 2Gadjah Mada University, Yogyakarta, Indonesia
Background : IgA nephropathy (IgAN) is the most common glomerular disease worldwide, especially in young adults and is a frequent cause of renal failure. Generally, the diagnosis of IgAN is based on clinical history, laboratory data, and histopathological findings. The rapidly progressive and crescentic subtype is quite uncommon.
Methods : In this case report, we present a 51-year-old Malay woman, with diabetes mellitus since four years, and experienced rapid deterioration of kidney function with vasculitis and fluid overload. Clinically, she showed edema, hematuria and hypertension. The patient underwent laboratory examination, and biopsy of the kidney and skin. Kidney biopsy specimen was examined on routine HE staining, histochemical staining of PAS, Masson’s trichrome, Congo red, orcein, von Kossa, and immunofluorescent staining using IgG, IgA, IgM, and C3 monoclonal antibody and examined under darkfield microscopy. The ANCA test using EIA methode.
Results : The ANCA was negative. Histopathological examination of skin biopsy specimen showed necrotizing vasculitis. Microscopic examination on kidney tissue showed severe mesangial expansion and some crescentics glomeruli. Immunofluorescent microscopy revealed mesangial deposition of IgA and C3. The diagnosis of rapidly progressive glomerulonephritis (RPGN) caused by IgAN was determined. Once diagnosis was established, management was done quickly and intensively to prevent chronic renal failure. The disease may be reversed, and vasculitis was improved after steroid therapy administration.
Conclusions : Kidney biopsy is done to establish the diagnosis of IgAN. An intensive therapy of RPGN is done to reverse the disease.
Keywords : IgA nephropathy, rapidly progressive glomerulonephritis, intensive therapy
My name is Metalia Puspitasari. I am an internist in Sardjito hospital Yogyakarta. I have graduated as a medical doctor and an internist from Gadjah Mada University.
I have accomplished my master degree of Medical Science Clinic in Gadjah Mada University.
Now I am in the 4th semesters of my fellowship nephrology program in Sardjito hospital Yogyakarta.
I have attended several workshop and training, such as dialysis Training (hemodialysis and peritoneal dialysis), dialysis Catheter Insertion Training, tenckhoff catheter insertion Training (CAPD), peritoneal dialysis workshop in Kuala Lumpur, renal color doppler and vascular ultrasound training.