Kidney Week 2025 Annual Meeting-Case Studies in Glomerular Diseases 2025

Video Transcription

Video Summary

The session opens with introductions and logistics for an ASN panel on real-world glomerular disease cases, led by renal pathologist Leil Hurlitz and nephrologist Quayle Jane, with expert panelists in IgA nephropathy, pediatrics, and glomerular medicine.

<strong>Case 1:</strong> A 28-year-old woman with Crohn’s disease develops recurrent gross hematuria. Initial workup suggests glomerular bleeding (acanthocytes) with minimal proteinuria and normal kidney function. Biopsy shows mild IgA nephropathy (M0E0S0T0C0), managed conservatively. Months later, despite Crohn’s control and medication changes, she worsens (proteinuria 1.4 g, rising creatinine). Repeat biopsy shows proliferative IgA nephropathy with crescents and 30% fibrosis. Panel debates therapy; she ultimately improves with systemic steroids plus mycophenolate. Discussion highlights IBD–kidney links, possible anti-TNF–related IgA mechanisms, and the importance of urine dip screening and close monitoring.

<strong>Case 2:</strong> A 16-year-old, extremely premature, obese hypertensive girl develops new nephrotic-range proteinuria after infectious diarrhea and NSAID use. Biopsy shows FSGS (NOS, possible early collapsing features), ~20% fibrosis, and only partial foot process effacement—suggesting secondary/adaptive disease. Genetic testing reveals APOL1 high-risk genotype, prompting discussion of supportive care (RAS blockade, SGLT2i, weight loss/GLP-1 agents) and APOL1-targeted clinical trials, plus complexities of broad genetic testing and VUS interpretation.

<strong>Case 3:</strong> A teen with systemic symptoms, cytopenias, hypocomplementemia, and glomerular hematuria has class IV+V lupus nephritis. Treatment strategy includes steroids, mycophenolate (or cyclophosphamide), hydroxychloroquine, and add-on biologics (belimumab/anti-CD20). The case evolves through multiple relapses, highlighting adherence challenges, repeat biopsies, escalating immunosuppression risks, and emerging CAR-T approaches for refractory lupus.

<strong>Case 4:</strong> A 74-year-old with fevers, weight loss, pancytopenia, positive serologies (ANA, MPO-ANCA, RF, low C3), and AKI has necrotizing crescentic immune-complex GN. Extensive workup reveals Bartonella endocarditis involving his valve/TAVR; antibiotics and valve replacement resolve renal and systemic findings. The panel stresses considering occult infection (especially Bartonella), careful immunosuppression decisions, and multidisciplinary collaboration—including veterinary insights on zoonoses.

Asset Subtitle

Moderator(s): Leal Herlitz, Koyal Jain

Presentation(s):

Case 1 - Jonathan Barratt
Case 2 - Kimberly Reidy
Case 3 - Pietro Canetta
Case 4 - Rupali Avasare

Support for all sessions in the Glomerular Diseases Learning Pathway is provided by an educational grant from Vera Therapeutics, Inc.

Meta Tag

Date 11/8/2025

Pathway 1 Glomerular Diseases

Pathway 2 Pathology

Session ID 507651

Keywords

ASN panel

real-world glomerular disease cases

IgA nephropathy

Crohn’s disease

inflammatory bowel disease kidney involvement

gross hematuria acanthocytes

Oxford classification M0E0S0T0C0

crescentic IgA nephropathy

systemic steroids and mycophenolate

focal segmental glomerulosclerosis (FSGS)

secondary/adaptive FSGS obesity hypertension

APOL1 high-risk genotype

lupus nephritis class IV+V

belimumab and anti-CD20 therapy

Bartonella endocarditis immune-complex GN