Cyclic neutropenia and concomitant IgA nephropathy: a case report

BACKGROUND

IgA nephropathy (IgAN) is universally recognized as one of the most common primary glomerular diseases in all ages. Cyclic neutropenia (CN) is a rare haematologic disorder that is associated with mutations of the ELANE gene. The co-occurrence of IgAN and CN is extremely rare. This is the first case report of a patient with IgAN and genetically confirmed CN.

CASE PRESENTATION

We report a case of a 10-year-old boy who presented with recurrent viral upper respiratory tract infections accompanied by several episodes of febrile neutropenia, haematuria, proteinuria and acute kidney injury. Upon first admission, his physical examination was unremarkable. His kidney function was impaired, whereas his urine microscopy showed evidence of macroscopic haematuria and proteinuria. Further workup showed elevated IgA. The renal histology was consistent with mesangial and endocapillary hypercellularity with mild crescentic lesions, while immunofluorescence microscopy showed IgA-positive staining, which was characteristic of IgAN. Moreover, genetic testing confirmed the clinical diagnosis of CN, therefore Granulocyte colony-stimulating factor (G-CSF) was initiated to stabilize the neutrophil count. Regarding proteinuria control, the patient was initially treated with an Angiotensin-converting-enzyme inhibitor for approximately 28 months. However, due to progressive proteinuria (> 1 g/24 h), Corticosteroids (CS) were added for a period of 6 months according to the revised 2021 KDIGO guidelines with favorable outcome.

CONCLUSIONS

Patients with CN are more susceptible to recurrent viral infections, which can trigger IgAN attacks. In our case CS induced remarkable proteinuria remission. The use of G-CSF contributed to the resolution of severe neutropenic episodes, viral infections and concomitant AKI episodes, contributing to better prognosis of IgAN. Further studies are mandatory to determine whether there is a genetical predisposition for IgAN in children with CN.

Atypical hemolytic-uremic syndrome (HUS) with recovery after a long-lasting anuria: a case report

We report a case of a seven-year-old girl who suffered from atypical Hemolytic Uremic Syndrome (aHUS) complicated by septicaemia, central nervous system involvement, and cholangiitis. She remained anuric requiring treatment with peritoneal dialysis (PD) for a five-month period. In addition to conventional therapeutic measures including fresh frozen plasma (FFP) and blood cells transfusions she also underwent to plasma exchange (PE) treatment. Following a stormy hospitalization period of 17 weeks, the patient finally regained renal function and three years later she remains well on antihypertensive treatment and free of dialysis.

Effect of the correction of anemia with recombinant human erythropoietin on growth of children treated with CAPD

Anemia correction with recombinant human erythropoietin (EPO) has been suggested to have a positive effect on nutritional status by improving appetite and protein metabolism. To assess this effect growth velocity and various parameters of nutritional status of 10 children on continuous ambulatory peritoneal dialysis (CAPD) were estimated at the start and one year after the correction of anemia. There was no significant improvement of growth velocity after EPO administration. Energy and protein intake, standard deviation scores of anthropometric measurements, BUN, serum creatinine, albumin, potassium, phosphorous and protein catabolic rate did not differ significantly before and after EPO administration. There was a significant correlation of protein intake and protein catabolic rate.

CONCLUSION

There was no significant improvement of nutritional status and growth of children on CAPD treated with EPO, possibly because there was no evidence of malnutrition in most patients.