D WIRASTUTI 1, I KUSWADI 1,H PRASANTO 1, M PUSPITASARI 1, Y WARDHANI 1
1Division of Nephrology and Hypertension, Department of Internal Medicine, Gadjah Mada University/Dr. Sardjito Hospital, Sleman, Indonesia
Background: Immunoglobulin A nephropathy (IgAN) or Berger’s disease, is the most common primary glomerular disease world wide and the most common type on glomerulonephritis in adult, but varies largely in its geographic distribution, with a global incidence of at least 2.5 per 100,000 per-year in adults. IgAN is more frequent in Asia population than in Caucasians. There was no difference in the proportion of patients based on sex, and the peak of distribution was the same in 20- and 30-year-old individuals of both sexes.
Case report: a 23-year-old male came with the major complaint of swelling of the face and legs since seven months ago. Laboratories finding proteinuria, hematuria, dysmorphic erythrocytes, protein creatinine ratio (PCR) 11,905mg/g, serum albumin 1.4mg/dl, cholesterol 837mg/dl, high-density lipoprotein (HDL) 52mg/dl, low-density lipoprotein (LDL) 582mg/dl, triglycerides 722mg/dl and screening for lupus, hepatitis c, hepatitis b, human immunodeficiency virus (HIV) and posts streptococcal glomerulonephritis were negative. Biopsy finding interstisial edema in tubulo-interstitial, red blood cell cast, interstitial fibrosis, and non-linier Immunoglobulin A (IgA) deposits, non-linier Immunoglobulin G (IgG) deposits, dan non-linier Immunoglobulin M (IgM) deposits in the glomerulus. This patient show poor response to steroid therapy, than we add on azathioprine (AZA) and there was remission following combination steroids and AZA.
Conclusion: Patient with IgA nephropathy response to combination therapy of corticosteroids and AZA. Steroids are the best choice for the treatment of IgAN. Azathioprine combined with steroids might be an alternative immunosuppressive therapy.
My name is Dwi Wirastuti, I was born in Yogyakarta at May 17, 1977, graduated general practitioner from Faculty of Medicine, Gadjah Mada University at 2001, Graduated Internal Medicine from Gadjah Mada University at 2014.
Now, I am a trainee of Nephrology and Hypertension subspecialization study program, Faculty of Medicine-Public Health and Nursing internal Medicine, Gadjah Mada University/Dr. Sardjito, Yogyakarta, Indonesia