A possible rare cause of renal failure in streptococcal infection

Abstract

To the best of our knowledge, this is the first biopsy-proven case of streptococcal infection-associated acute interstitial nephritis (AIN) with existence of streptococcal pyrogenic exotoxin B (SPE B) by a controlled immunohistochemical method. Both the intact tubular epithelial cells and oedematous interstitium had strong positive signals, whereas only interstitial inflammation was dominant without tubular necrosis. Reflective of the nature of AIN is that the injury from the hypersensitivity reaction was specific for renal interstitium instead of tubules. SPE B is potentially allergenic and may confuse the clinicians due to its clinical mimicry of drug-induced AIN. Although very rare, AIN might be included into the differential diagnosis of patients with streptococcal sepsis and acute renal failure.

Glomerular Deposition of Nephritis-Associated Plasmin Receptor (NAPlr) and Related Plasmin Activity: Key Diagnostic Biomarkers of Bacterial Infection-related Glomerulonephritis

“…Interestingly, a case of PSAGN complicated by acute interstitial nephritis, in which positive SPEB immunostaining was observed in the interstitium as well as in the glomeruli, has been reported [35]. Although acute tubulointerstitial nephritis after streptococcal infection without obvious GN is rare, such a case has indeed been reported, in which SPEB immunostaining was positive in the affected area [36]. In the former case report [35], the authors also performed immunofluorescence staining of NAPlr using a commercially available antibody but failed to detect its deposition.…”

A young girl with an unusual cause of acute kidney injury: Answers

“…This may actually be the first report of acute haemorrhagic interstitial nephritis due to streptococcal infection. There are three mechanisms by which streptococcal infection can conduce to acute kidney injury (AKI) [ 8 ]. First, acute post-streptococcal glomerulonephritis (APSGN) may result from scarlet fever or group A streptococcal skin infections.…”

Tubulointerstitial nephritis: diagnosis, treatment, and monitoring

“…Overall, drug-induced TIN has been noted in 7-27 % of adult patients with unexplained non-oliguric or oliguric AKI [13]. Infectious causes of TIN include viral, bacterial, fungal or parasitic [14-16]. TIN has been reported as the third leading cause of graft dysfunction in renal transplant patients [17].…”