Abstract: TH-PO946
IgA Nephropathy in Patients with Psoriatic Arthritis: A Case Series and Systematic Review of the Literature
Session Information
- Glomerular Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Steinmetz, David, University of Pennsylvania, Woodbridge, Connecticut, United States
- Qiu, Maylene Kefeng, University of Pennsylvania, Woodbridge, Connecticut, United States
- Palmer, Matthew, University of Pennsylvania, Woodbridge, Connecticut, United States
- Dunham, Jonathan, University of Pennsylvania, Woodbridge, Connecticut, United States
- Hogan, Jonathan J., Hospital of the University of Pennsylvania, Haddonfield, New Jersey, United States
Introduction
There are cases in the literature of patients with IgAN and PsA, leading to the hypothesis that they may be biologically associated. Here, we present 2 cases and a systematic review of the literature of IgAN coexisting with PsA.
Case Description
Case 1: A 26 year-old man with a history of psoriasis in childhood was diagnosed with PsA at age 20 after developing back pain and bilateral dactylitis. NSAIDs and leflunomide were ineffective, but arthralgias improved on oral methotrexate and adalimumab. SCr was 1.1-1.3 mg/dL (eGFR 52 mL/min) and UA showed 2+ blood, trace protein, 10-20 RBCs/hpf and no WBCs. UPCR ranged from 100-300 mg/g. Microhematuria persisted and Cr increased to 1.6. A kidney biopsy showed IgAN (Oxford M1, E1, S0, T0, C1). He continued on methotrexate and adalimumab; 3 years later, SCr is 1.1, he has normal proteinuria and no hematuria.
Case 2: A 56 year-old woman had severe psoriasis since childhood and a 10-year history of PsA (axial and non-axial joints) controlled with infliximab until she stopped treatment due to atypical mycobacterial pneumonia. She then presented with AKI requiring hemodialysis. Kidney biopsy showed IgAN (M1, E1, S1, T0) and AIN, attributed to rifampin or ethambutol. She was treated with prednisone and recovered kidney function after 20 days. One year later, she presented with shortness of breath, edema, eGFR 9 mL/min, UPCR 3.64, and microhematuria. Repeat kidney biopsy showed IgAN (M1, E1, S1, T1). She was treated with steroids and cyclophosphamide, with improvement to eGFR 22 mL/min. Four months later, she expired with unknown cause of death.
Discussion
Literature Review
Our systematic review of the literature identified 16 additional cases of coexisting IgAN and PsA dating back to 1982. Including our two, the cases comprise 14 male and 4 female patients from the USA, Europe, and Japan. Median age of diagnosis of PsA and IgAN were 42 and 47, respectively, with only 1 pediatric case. PsA predated IgAN in 10 patients (median time from PsA to IgAN diagnosis in these patients 5 years). Serum IgA levels were elevated in 7/8 patients for whom this was described. There is heterogeneity in these patients’ presentations, treatments, and outcomes.
Conclusion
Further study is warranted to determine whether there is a pathophysiological link between IgAN and PsA.