Extracapillary immunoglobulin A nephropathy glomerulonephritis discovered during the course of pulmonary tuberculosis: a case report

Abstract

Few cases of immunoglobulin A nephropathy (IgAN) associated with tuberculosis have been described in the literature. We report an atypical case of extracapillary IgA glomerulonephritis discovered during the course of pulmonary tuberculosis. The patient, a 45-year-old diagnosed with pulmonary tuberculosis, presented with mixed nephrotic syndrome, characterized by hypertension, hematuria, and acute renal failure. We completed a renal biopsy which showed IgAN with diffuse crescents, classified as (M1E1S1T0C2) according to the Oxford classification. The patient was treated with high-dose of intravenous corticosteroids followed by oral tapering. The antituberculous quadruple therapy was extended to 2.5 months then followed by dual therapy. The course was marked by recovery from pulmonary tuberculosis and a significant improvement in creatinine levels, from 504 µmol/l to 262 µmol/L in five months, but the nephrotic syndrome persisted. In the absence of specific guidelines, this case demonstrates that individualized corticosteroid therapy may be considered in extracapillary IgA glomerulonephritis associated with tuberculosis.