Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy
Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis rarely affects females of reproductive age. A 28-year-old African American woman presented at 8 weeks of gestation with intractable vomiting attributed to hyperemesis gravidarum. She was found to have acute kidney injury that was unres...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2016/1075659 |
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| author | Ryan Kunjal Raafat Makary Andreea Poenariu |
| author_facet | Ryan Kunjal Raafat Makary Andreea Poenariu |
| author_sort | Ryan Kunjal |
| collection | DOAJ |
| description | Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis rarely affects females of reproductive age. A 28-year-old African American woman presented at 8 weeks of gestation with intractable vomiting attributed to hyperemesis gravidarum. She was found to have acute kidney injury that was unresponsive to vigorous fluid resuscitation and urine sediment examination was suggestive of an underlying glomerulonephritis. Serum c-ANCA and PR3 were elevated and there was no peripheral eosinophilia. During her course she also developed one episode of small volume hemoptysis with right upper lobe infiltrates on CT Chest. There were no cutaneous manifestations of vasculitis or upper respiratory symptoms. Renal biopsy revealed a pauci-immune crescentic glomerulonephritis (PICGN). The diagnosis was consistent with granulomatosis with polyangiitis (GPA). Management initially comprised teratogen sparing agents; steroids, intravenous immunoglobulin; and plasma exchange. The response was suboptimal and she became dependent on daily renal replacement therapy. Ultimately the pregnancy was terminated allowing for traditional treatment approaches with dramatic effect. This is the first case of GPA presenting as PICGN in pregnancy and highlights the challenges of its management. |
| format | Article |
| id | doaj-art-9b750e00bf5c4323bbcabdcc36a3d7ce |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Nephrology |
| spelling | doaj-art-9b750e00bf5c4323bbcabdcc36a3d7ce2025-02-03T01:22:46ZengWileyCase Reports in Nephrology2090-66412090-665X2016-01-01201610.1155/2016/10756591075659Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in PregnancyRyan Kunjal0Raafat Makary1Andreea Poenariu2Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL 32209, USADepartment of Pathology, University of Florida College of Medicine, Jacksonville, FL 32209, USADepartment of Nephrology, University of Florida College of Medicine, Jacksonville, FL 32209, USAAntineutrophil cytoplasmic antibody (ANCA) associated vasculitis rarely affects females of reproductive age. A 28-year-old African American woman presented at 8 weeks of gestation with intractable vomiting attributed to hyperemesis gravidarum. She was found to have acute kidney injury that was unresponsive to vigorous fluid resuscitation and urine sediment examination was suggestive of an underlying glomerulonephritis. Serum c-ANCA and PR3 were elevated and there was no peripheral eosinophilia. During her course she also developed one episode of small volume hemoptysis with right upper lobe infiltrates on CT Chest. There were no cutaneous manifestations of vasculitis or upper respiratory symptoms. Renal biopsy revealed a pauci-immune crescentic glomerulonephritis (PICGN). The diagnosis was consistent with granulomatosis with polyangiitis (GPA). Management initially comprised teratogen sparing agents; steroids, intravenous immunoglobulin; and plasma exchange. The response was suboptimal and she became dependent on daily renal replacement therapy. Ultimately the pregnancy was terminated allowing for traditional treatment approaches with dramatic effect. This is the first case of GPA presenting as PICGN in pregnancy and highlights the challenges of its management.http://dx.doi.org/10.1155/2016/1075659 |
| spellingShingle | Ryan Kunjal Raafat Makary Andreea Poenariu Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy Case Reports in Nephrology |
| title | Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy |
| title_full | Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy |
| title_fullStr | Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy |
| title_full_unstemmed | Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy |
| title_short | Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy |
| title_sort | granulomatosis with polyangiitis presenting as pauci immune crescentic glomerulonephritis in pregnancy |
| url | http://dx.doi.org/10.1155/2016/1075659 |
| work_keys_str_mv | AT ryankunjal granulomatosiswithpolyangiitispresentingaspauciimmunecrescenticglomerulonephritisinpregnancy AT raafatmakary granulomatosiswithpolyangiitispresentingaspauciimmunecrescenticglomerulonephritisinpregnancy AT andreeapoenariu granulomatosiswithpolyangiitispresentingaspauciimmunecrescenticglomerulonephritisinpregnancy |