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Case Reports
. 2018 Jun 13:2018:9231989.
doi: 10.1155/2018/9231989. eCollection 2018.

Atypical Presentation of IgA Nephropathy Mimicking Acute Pyelonephritis

Stamatis Karakonstantis  1 , Despoina Galani  1 , Dafni Korela  1 , Sofia Pitsigavdaki  1 , Ifigeneia Kassotaki  1 , Despoina Arna  1 , Dimitrios Xydakis  2
Affiliations
Case Reports

Atypical Presentation of IgA Nephropathy Mimicking Acute Pyelonephritis

Stamatis Karakonstantis et al. Case Rep Med. .

Abstract

Background: IgA glomerulonephritis may present with hematuria, flank pain, and fever. This clinical presentation may be easily confused with acute pyelonephritis.

Case report: We present the case of a 25-year-old female with a typical clinical presentation for acute pyelonephritis (high fever, left flank pain, left costovertebral angle tenderness, hematuria, elevated inflammatory markers, and a hypoenhancing region in the left kidney on contrast-enhanced computed tomography). However, urine and blood cultures were both negative, the serum creatinine was elevated, and the urinalysis revealed significant proteinuria and dysmorphic red blood cells. A kidney biopsy confirmed a diagnosis of IgA nephropathy. She was treated with a combination of lisinopril and methylprednisolone, with good response.

Conclusion: Gross hematuria, especially in the absence of pyuria or bacteriuria, should raise the suspicion for underlying IgA nephropathy, even if the rest of the clinical presentation is typical for a urinary tract infection. The presence of significant proteinuria, red blood cell casts, and dysmorphic red blood cells are useful clues suggesting glomerular disease.

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Figures

Figure 1
Figure 1
Contrast-enhanced computed tomography demonstrating a hypoenhancing region in the left kidney.
See this image and copyright information in PMC

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