ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: TH-PO702

Sinister Synergy: IgA Nephropathy and Apixaban

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Baker, Atlee, Washington University in St Louis, St Louis, Missouri, United States
  • Matzumura Umemoto, Gonzalo, Washington University in St Louis, St Louis, Missouri, United States
Introduction

IgA nephropathy is the most common glomerulonephritis worldwide, divided into primary and secondary types. Oral anticoagulants have been associated with acute kidney injury, although less well defined. We present a case of IgAN made more severe with the addition of Apixaban.

Case Description

A 75-year-old male with history of recently diagnosed atrial fibrillation on Apixaban, systolic heart failure, and prior EtOH abuse who presented for evaluation of lower extremity edema. He developed rapid onset of stage 3 AKI (sCr 4mg/dL, baseline 1mg/mL) over one month and gross hematuria 1 week prior to presentation. Urinalysis revealed >50 RBCs; UPCR 1.8g/g. Urine microscopy revealed mixed cellular casts. Broad serological work up was negative. C3/C4 levels normal. Infectious work up was negative. US revealed mild liver contour changes concerning for mild cirrhosis. Renal biopsy with findings of IgAN (3+ IgA/C3 in the mesangium and tubular lumen, low mesangial expansion and endocapillary proliferation, no crescents), and numerous RBC casts. Findings were attributed to secondary IgAN with cirrhosis, with other findings suggestive of anticoagulant-related nephropathy. Given the rapid progression of his disease, patient was started on high-dose steroids. Apixaban was held with resolution of hematuria. Patient’s renal function subsequently improved and Apixaban was restarted.

Discussion

We present a case of sIgAN complicated by the addition of anticoagulation. Our case is unique as the patient presented with rapidly progressive and severe renal injury, without characteristic findings of aggressive disease on biopsy. Our case highlights the role that anticoagulation can have worsening glomerular disease.

IgA Mesangial Staining

RBC Casts