Abstract: PUB015
From Tubular Injury to Membranoproliferative Glomerulonephritis: A Complex Case of AKI
Session Information
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Llama, Adrian, Yale University School of Medicine, New Haven, Connecticut, United States
- Garcia, Alejandro S., Yale New Haven Health System, New Haven, Connecticut, United States
Introduction
Acute kidney injury (AKI) is a common complication in hospitalized patients, with intrinsic causes like acute tubular injury (ATI), interstitial nephritis (IN), and glomerular injury accounting for 30% of cases. Rarely, aminoglycosides in antibiotic-loaded spacers for prosthetic joint infections can cause ATI and glomerular toxicity. IN is often drug-related, with penicillins strongly associated. Membranoproliferative glomerulonephritis (MPGN), a type of glomerular injury, can be triggered by infections.
Case Description
We present a 71-year-old woman with comorbidities including RA on prednisone and bilateral knee replacements who developed septic shock from a prosthetic joint infection. Despite surgery and tobramycin-vancomycin spacers, she had poor wound healing. Further debridement, spacer placement, and flap surgery were performed. Prednisone was reduced due to poor healing. Renal failure developed 14 days post-op without hemodynamic insults. Urine showed granular and RBC casts. Biopsy revealed severe ATI from tobramycin induced tubular injury, AIN, and MPGN. This case highlights the importance of multifactorial AKI. ATI was likely the main driver due to high-dose tobramycin spacers, but IN and MPGN suggest roles for drug exposure, and infection.
Discussion
Renal biopsy is crucial for rapidly progressive AKI with RBC casts, identifying pathological processes for targeted treatment. High suspicion for multifactorial AKI is needed. The patient's ATI was linked to prolonged exposure to tobramycin spacers, with higher doses and longer duration increasing AKI risk. IN treatment is usually corticosteroids, but evidence is limited and was deferred to avoid poor wound healing and recurrent infection. Prednisone reduction may have contributed by unmasking doormant AIN. MPGN was also present with immunoglobulin and complement deposits. Ampicillin was stopped, infection treated, steroids deferred, and spacer remained to avoid surgical risks. She made a full recovery.