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Case description
Clinical findings
• In the emergency department, examination The biopsy
demonstrated a significant hypertension specimen shows
proliferation of
194/109mmHg the mesagium,
with IgA deposits
Laboratory studies on immunofluore
scence and electr
• Tests showed anemia 8.2/25.3, metabolic acidosis pH on microscopy.
7.22, HCO3 16, PCO2 40, anion gap 18, and BUN/Cr
192/15.1. U/A showed 300 mg/dL of protein and
large hemoglobin but no gross hematuria. Cellular/fibrous crescents,
fibrinoid necrosis, and global
Laboratory and imaging studies sclerosis
Glucocorticoids
+cyclophospha
mide followed
by azathioprine
Glucocorticoids
?
plus
azathioprine
Discussion
Despite IgAN is the most common glomerulonephritis in the Western world, a particular rapid progression to ESRD is
uncommon (< 10%) . In this patient, the rapid clinical deterioration and histopathological presence of cellular/fibrous
crescents, fibrinoid necrosis, and global sclerosis were suggestive of active glomerular injury in a background of
cortical chronic injury. In particular, the treatment of crescentic, rapidly progressive glomerulonephritis in patients with
IgAN has not been evaluated in randomized trials.