Kidney Week 2025 Early Program - Glomerular Diseases: 2025 Update-Clinicopathologic Conference 1: Nephritis

Video Transcription

Video Summary

The transcript introduces a clinicopathologic conference (CPC) featuring multiple presenters and discussants, built around challenging nephrology cases.

<strong>Case 1</strong> describes a 42-year-old man with a prior bioprosthetic aortic valve replacement who presents with constitutional “B symptoms” and rapidly progressive kidney injury with hematuria and subnephrotic proteinuria. Serologies are confusingly broad (positive ANA, rheumatoid factor, high PR3-ANCA, low C3, high ASO), and initial infectious workup and echocardiography are negative. Kidney biopsy shows necrotizing crescentic GN with <strong>immune-complex “full house” mesangial deposits</strong>, suggesting overlap rather than classic pauci-immune ANCA vasculitis. Despite concern for occult infection, he receives steroids and cyclophosphamide, then returns with MRSA bacteremia. Ultimately, advanced imaging identifies an <strong>aortic root abscess</strong>, surgically repaired with good renal recovery. Persistent low-level ANCA and hematuria raise concern, but repeat biopsy shows only fibrous crescents; the teaching point is to <strong>treat the patient, not ANCA titers</strong>, and to aggressively evaluate for deep-seated infection when serologies don’t fit a single autoimmune diagnosis.

<strong>Case 2</strong> features a 66-year-old woman with metastatic ovarian cancer on long-term <strong>bevacizumab</strong> who develops hypertension and proteinuria with preserved kidney function. Discussion emphasizes likely VEGF-inhibitor–associated glomerular TMA-like injury, often without systemic hemolysis, and management prioritizing oncologic benefit with supportive antiproteinuric/antihypertensive therapy and individualized decisions about drug continuation.

A <strong>pediatric case</strong> follows: a 9-year-old with GN and low complement initially resembling post-infectious GN, but persistent abnormalities prompt repeat biopsy revealing <strong>dense deposit disease (C3 glomerulopathy)</strong>, leading to discussion of complement-focused evaluation and emerging targeted therapy.

Asset Subtitle

Duvuru Geetha, Keisha L. Gibson, Richard A. Lafayette, Samir V. Parikh, Dominick Santoriello, Meghan E. Sise, Benjamin Wooden

Meta Tag

Module GLOM

Speaker FACULTY FACULTY

Keywords

clinicopathologic conference

nephrology case discussion

rapidly progressive glomerulonephritis

necrotizing crescentic GN

full house immune-complex deposits

PR3-ANCA positivity

infective endocarditis mimic

aortic root abscess

MRSA bacteremia

bevacizumab-associated thrombotic microangiopathy

dense deposit disease (C3 glomerulopathy)