Abstract: SA-PO302
Post-Implantation Syndrome Following Abdominal Aortic Aneurysm Repair Causing Podocytopathy
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Cavanaugh, Corey J., Yale University School of Medicine, New Haven, Connecticut, United States
- Luciano, Randy L., Yale University School of Medicine, New Haven, Connecticut, United States
Introduction
A systemic inflammatory response of fever, leukocytosis, and pleural effusion following various vascular interventions including endovascular aortic repair (EVAR) is well recognized phenomena known as post-implantation syndrome. We describe a case of podocytopathy following EVAR.
Case Description
A 69-year-old man with no significant previous medical history presented with fevers progressive generalized edema and shortness of air after undergoing EVAR for ruptured abdominal aortic aneurysm (AAA) one month prior. He underwent repeat CT of the chest abdomen and pelvis, revealing bilateral pleural effusions that were proven exudative, with intact endovascular repair. His serum albumin fell to 2.0g/dl from a previous baseline of 3.8g/dl, with 2+ proteinuria on urinalysis. Urine microscopy was notable for Maltese crosses reflecting lipid droplets. The serum creatinine (SCr) remained at baseline of 1.4 mg/dl. A renal biopsy showed 4 glomeruli, 1 with global sclerosis, focal interstitial infiltrate of lymphocytes and plasma cells, global foot process effacement on electron microscopy without immune complex deposition. Immunofluorescence was not completed. A final diagnosis of MCD or unsampled primary focal segmental glomerulosclerosis (FSGS) was given by the renal pathologist and given scarring with interstitial infiltrate a clinical diagnosis of FSGS was more likely. A unifying diagnosis of post-implantation syndrome was made after an extensive infectious, vasculitis, and rheumatologic work up were negative. Prednisone 60mg daily with loop diuretics was started. Upon follow up his serum albumin rose to 3.6g/dl, his edema and pleural effusions had resolved.
Discussion
Post-implantation syndrome describes the clinical entity of systemic inflammatory response after repair of AAA. The incidence of the syndrome has been reported to vary widely between 3% and 60% for AAAs. We describe the first case of podocytopathy following EVAR in a patient with post-implantation syndrome, that responded to corticosteroids.