Y WARDHANI1, H PRASANTO2, I KUSWADI2
1Student of Nephrology Consultant Program, Sardjito General Hospital, , Indonesia, 2Staff of Division of Nephrology and Hypertension, Department of Internal Medicine, Sardjito General Hospital, Indonesia
Background: Immunoglobulin A nephropathy has been identified as the most common type of adult primary glomerulonephritis. Crescentic form on histologic finding of patient with IgA nephropathy is significant predictive factor on progression to ESRD. Several important risk factors on clinical and laboratory findings predict the poor outcome for progressive renal disease, including severe proteinuria, hypertension and elevated serum creatinine concentration. Currently, studies on the treatment of IgA nephropathy are still limited.
Case Report: We present 19-year-old-female patient with macroscopic hematuria, severe proteinuria (+4 by dipstic), hypertension, elevation on initial serum creatinine concentration (1.89 mg/dL), and kidney biopsy proven for IgA nephropathy, screening for lupus, hepatitis B, hepatitis C, and human immunodeficiency virus were negative. The patient was treated using the combination of prednisolone (0.8 mg/kg/d) and cyclosporine (4 mg/kg/d), and angiotensin receptor blocker agent. After 12-weeks of therapy, there were reduction in proteinuria (+2 by dipstic), hematuria and serum creatinine concentration (0.8 mg/dL), followed by improvement in serum albumin concentration.
Conclusion: Treatment of crescentic IgA Nephropathy using the combination of steroid and cyclosporine showed satisfactory improvement in both clinical and laboratory findings. This case report provides an overview regarding the combination of steroid and cyclosporine for the treatment of crescentic IgA nephropathy.
Key words: IgA nephropathy, crescent, proteinuria, cyclosporine
Yulia Wardhani is a student of nephrology consultant fellowship program in Sardjito General Hospital Yogyakarta and also a staff of Division Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Gadjah Mada. She was graduated from medical doctor degree in 2008, and specialty in Internal Medicine in 2016.