Maggio Giugno 2024 - Articoli originali

An Unusual Case of Alcoholic Liver Disease Associated with Secondary IgA Vasculitic Nephritis presenting as Rapidly Progressive Glomerulonephritis

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Shruthi Muralidharan

DOI: 10.69097/41-03-2024-09

Shruthi Muralidharan1, Gerry George Mathew1, Varadharajan Jayaprakash1, Sreedhar Sailapathy1

1 SRM, Medical College Hospital and Research Centre

Corresponding author:
Shruthi Muralidharan
8-9E 3 RD PHASE, Wood Creek County, ST
Thomas Mount PO
Chennai 600016
Phone: +91 9884075591
E-mail: shruthi.muralidharan@gmail.com

 

Abstract

IgA nephropathy (IgAN) is a fairly common association with alcoholic liver disease. However, IgA vasculitis (IgAV) is quite an uncommon association with alcoholic liver cirrhosis and only a handful of cases have been reported in literature. Secondary IgAN usually presents in a docile manner, progressing slowly in about 5-25 years. It is usually responsive to steroid therapy, very rarely progressing to End-Stage Renal Disease.

Here, we present a man in his late 50s, a known hypertensive and alcohol related liver-cirrhotic, who presented to our hospital with rash and rapidly progressive renal failure (RPRF). He was diagnosed with IgA nephritis with IgA vasculitis (IgAVN). His diagnosis was confirmed with skin and renal biopsy.

He was started on renal replacement therapy for his renal failure and began oral steroid therapy. After administration of steroid therapy for 6 months, the patient recovered and was dialysis independent with stable renal parameters.

Keywords: IgA nephropathy, Alcoholic Liver disease, rapidly progressive glomerulonephritis, IgA vasculitis

Background

Secondary IgA nephropathy is a well-known complication of alcohol related chronic liver disease [1], however, IgA vasculitis with nephropathy secondary to liver disease is quite rare and only a handful of cases have been reported in literature.

The presentation of IgA nephropathy secondary to liver cirrhosis varies from clinically silent disease to nephrotic or nephritic syndromes [2]. Very rarely, it can present as end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). The natural progression involves development of end stage renal disease within 20 years of presentation [3]. The incidence of rapidly progressive renal failure in IgA nephropathy in less than 10%. 

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