IgA nephropathy in cirrhotic patients: diagnostic and therapeutic implications. A case series.

Abstract

Renal dysfunction in patients with liver cirrhosis represents a diagnostic challenge due to the coexistence of multiple etiologies and the overlap between functional and structural mechanisms. In this setting, errors in etiological attribution may lead to inappropriate therapeutic decisions. We report two cases of IgA nephropathy in cirrhotic patients illustrating opposite diagnostic pitfalls. The first case involved a patient with liver cirrhosis in whom renal dysfunction was initially attributed to hepatorenal syndrome despite abnormal urinary sediment findings, delaying the diagnosis of IgA nephropathy until kidney biopsy was performed. The second case concerned a patient with IgA nephropathy initially considered primary and treated with immunosuppressive therapy until decompensated liver cirrhosis was subsequently identified, leading to reclassification as secondary IgA nephropathy. These cases highlight how a simplified interpretation of renal dysfunction in cirrhotic patients may result in diagnostic errors with relevant therapeutic implications. Dynamic clinical reassessment, integration of clinical and laboratory findings, and consideration of kidney biopsy in selected cases are essential to establish an accurate etiological diagnosis.

Keywords: IgA nephropathy, cirrhosis, hepatorenal syndrome, renal biopsy.