Kidney Week

Abstract: SA-PO880

Anti-neutrophil CytoplasmAntibody-Associated Vasculitis as Paraneoplastic Glomerular Disease

Session Information

• Glomerular Diseases: Case Reports - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Gallegos, Belén, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Belén Gallegos, PharmD, MEd, MS, MSc

• Amador Reyes, Laura Gabriela, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Laura Gabriela Amador Reyes, MD

• Ruiz Saucedo, Gonzalo, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Gonzalo Ruiz Saucedo, MD

• Fuentes-Mendez, Laura del C, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Laura del C Fuentes-Mendez, MD

• Cordoba Hurtado, Angela Maria, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Angela Maria Cordoba Hurtado, MD

• Perez-Navarro, L. Monserrat, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

L. Monserrat Perez-Navarro, PhD, MPH

• Soto, Virgilia, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Virgilia Soto, MD

• Figueroa Gamiño, Diana Laura, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Diana Laura Figueroa Gamiño, MD, MEd

• Velasquez Lorenzo, Ingrid Rosario, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico

Ingrid Rosario Velasquez Lorenzo, MEd, MSc

Introduction

Paraneoplastic glomerulonephritis (PGN) is a rare complication of a malignant tumor, with glomerular lesions induced by products of tumor cells. ANCA-associated vasculitis (AAV) occurs in 14-20% of paraneoplastic syndromes associated with renal tumors; 71% are clear-cells carcinoma. In Latin America there are no cohorts that evaluate the association of AAV and renal cell carcinoma.

Case Description

CASE 1: 51 years old male, admitted requiring KRT. We found active urinary sediment and positive anti-MPO. An image of a kidney tumor was found in the echography, later confirmed with CT. Patient had a partial nephrectomy, with pathology result showing clear cell renal cell carcinoma and pauci-immune crescentic glomerulonephritis with focal and segmental sclerosis and grade II interstitial fibrosis.

CASE 2: 56 years old male, admitted due to uremic syndrome, and behavior of rapidly progressive glomerulonephritis, starting KRT. We found positivity for anti-MPO, evidence of a kidney tumor in echography and TC. A renal biopsy was performed, reporting active pauci-immune crescentic glomerulonephritis and grade II interstitial fibrosis. He was treated with complete nephrectomy four months later, pathology confirmed clear cell renal carcinoma.

CASE 3: 44 years old male, with granulomatosis with polyangiitis since 2020, referred because of proteinuria and chronic kidney disease. Ecography showed a renal tumor, CT was performed suggesting clear cell renal carcinoma.

Discussion

The course of PGN is a rare diagnostic and a therapeutic challenge, so early identification and treatment with close follow-up could help improve the prognosis. It is reasonable to treat AAV with standard immunosuppression, including steroids and/or cyclophosphamide and/or rituximab, given the high associated morbidity and mortality, along with planned cancer treatment.