What is your approach to a patient with IgG4RD with past pulmonary involvement (biopsy proven) managed with steroids alone, now with new hematuria/proteinuria, but stable renal function?
Would you obtain renal biopsy first or treat with additional immunosuppression for suspected renal involvement related to IgG4?
Answer from: at Academic Institution
Significant hematuria is not a typical feature of IgG4-related kidney disease. IgG4-RKD most commonly presents as tubulointerstitial nephritis (TIN), which presents as mild, non-nephrotic range proteinuria. In fact, urinalysis in the context of TIN is often normal, as the proteinuria is largely non-...
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Answer from: at Community Practice
New onset hematuria/proteinuria in such a patient is definitely concerning. I usually do a kidney biopsy as it would help me rule out any superimposed GN, and give me an idea about how well am I managing their IgG4RD. If there is no other etiology and interstitial nephritis is found, that would be a...
Answer from: at Academic Institution
Thanks @Guy for the wonderful response! Would also add to check complements. While the presence of low complements is of course non-specific as to etiology, hypocomplementemia has been described in renal involvement/TIN from IgG4-RD.
Comments
at Massachusetts General Hospital
Absolutely, C3 and C4 should be checked in all pat...
Absolutely, C3 and C4 should be checked in all pat...
at Duke University Medical Center
Thanks for the reply and your insights! I mostly i...
Thanks for the reply and your insights! I mostly i...
at Massachusetts General Hospital
Thanks for bringing up this important point about ...
Thanks for bringing up this important point about ...
Answer from: at Community Practice
I would check the compliment profile, possible associated IgA nephropathy.