Bacterial infection–related glomerulonephritis in adults

Nasr, Samih H.; Radhakrishnan, Jai; D’Agati, Vivette D.

doi:10.1038/ki.2012.407

Cited by 225 publications

(241 citation statements)

References 105 publications

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“…Nasr et al reported the following five characteristic criteria of infection-related glomerulonephritis: (1) clinical or laboratory evidence of infection preceding or at the onset of glomerulonephritis; (2) depressed serum complement; (3) endocapillary proliferative and exudative glomerulonephritis; (4) C3-dominant or co-dominant glomerular immunofluorescence staining; and (5) hump-shaped subepithelial deposits on electron microscopy. Of 86 patients with infection-related glomerulonephritis, 37 % fulfilled all five criteria, 41 % fulfilled 4 of the 5 criteria, and 22 % fulfilled 3 of the 5 criteria [13]. In the present patient, as shown in Fig.…”

Section: Discussionmentioning

confidence: 51%

Repeated acute kidney injury associated with Mycobacterium gordonae infection

et al. 2014

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Mycobacterium gordonae is a nontuberculous mycobacterium widely distributed in the environment. Although M. gordonae is not usually pathogenic and glomerular lesions due to M. gordonae are very rare, infection has been reported in both immunocompromised patients and healthy persons. We report a case of acute kidney injury (AKI) in which M. gordonae was ultimately identified as the cause. A 70-year-old man was admitted to our hospital because of fever, polyarthritis, and AKI. He was a hepatitis B virus carrier, suffered from diabetes, and had a past history of erysipelas. No causative bacteria were identified, but coexisting infection was suspected. The patient experienced remission with antibiotic therapy, but the same symptoms recurred eight times. Blood polymerase chain reaction was performed during the 7th recurrence, and M. gordonae was detected. Clarithromycin was initiated, but 2 years after initial hospitalization, the patient died due to M. gordonae infection. In this case, acute kidney injury was a consequence of infection-related glomerulonephritis due to M. gordonae. Mycobacterium is difficult to detect by routine culture methods; therefore, diagnosis remains challenging.

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Section: Discussionmentioning

confidence: 51%

Repeated acute kidney injury associated with Mycobacterium gordonae infection

et al. 2014

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“…A substantial number of cases now occur in adults, particularly the elderly, alcoholic persons, and patients who are immunocompromised. Because the presence of an infection is often ongoing at the time of renal biopsy, the term infectionrelated GN has been suggested as more appropriately describing this condition (6). In contrast to children, adults are more likely to have infection-related GN secondary to nonstreptococcal infections, particularly staphylococcal infection, and the overall prognosis in terms of renal and patient survival is poor.…”

Section: Discussion Of Questionmentioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2012

Fervenza

Glassock

Bleyer

2013

Clinical Journal of the American Society of Nephrology

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SummaryPresentation of the Nephrology Quiz and Questionnaire (NQQ) has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session, judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire. The topic presented here is GN. Cases representing this category, along with single best answer questions, were prepared by a panel of experts (Drs. Fervenza, Glassock, and Bleyer). The correct and incorrect answers were then briefly discussed after the audience responses and the results of the questionnaire were displayed. This article recapitulates the session and reproduces its educational value for a larger audience-that of the readers of the Clinical Journal of the American Society of Nephrology. Have fun.Clin J Am Soc Nephrol 8: 1460-1465, 2013. doi: 10.2215/CJN.00440113 GN Case 1A 20-year-old woman was referred for evaluation of persistent hematuria and proteinuria. She had a history of fever and sore throat lasting 1 week that occurred 6 months earlier and were associated with abdominal pain and dark urine. She did not receive any antimicrobial agents. Significant findings on physical examination at that time included a BP of 140/90 mmHg and 2+ edema. Laboratory evaluation showed a serum creatinine value of 1.4 mg/dl, urinalysis with 2+ protein and 3+ blood, and a 24-hour urinary protein excretion of 680 mg. The C3 level was 46 mg/dl (reference range, 75-175 mg/dl) and the C4 level was 23 mg/dl (reference range, 14-40 mg/dl). A throat culture was negative for b-hemolytic streptococci, and an antistreptolysin O titer was 200 IU/ml (upper limit of normal, 200 IU/ml). The serum albumin concentration was 3.6 g/dl.A renal biopsy was performed and showed a pattern of membranoproliferative GN on light microscopy. No crescents were observed. Immunofluorescence microscopy showed bright (3+) mesangial and capillary wall C3 staining. Electron microscopy showed mesangial, intramembranous, and subendothelial deposits, as well as a few subepithelial hump-like deposits. Postinfectious GN and type III membranoproliferative GN were diagnosed. The patient was treated symptomatically, but proteinuria and hematuria persisted. Current evaluation shows a hemoglobin level of 11.8 g/dl, a serum creatinine concentration of 1.3 mg/dl, urinalysis with 3+ blood and 3+ protein, quantitative proteinuria of 2.2 g/24 hours, C3 concentration of 44 mg/dl, and C4 concentration of 22 mg/dl. Question 1 (see Figure 1 for responses of program directors and attendees)To further evaluate this patient, you would now order:A. Antinuclear antibodies B. Hepatitis B and C serology C. Anti-deoxyribonuclease (DNase) antibody titers D. Serum C1q level E. Antibodies to complement-regulating ...

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“…The most common extrarenal manifestation is congestive heart failure. 6,7 In contrast to PIGN, Streptococcus pyogenes is not a common cause of bacterial pericarditis. 8 A literature review revealed eight prior cases of purulent pericarditis caused by Streptococcus pyogenes and one case of constrictive pericarditis.…”

Section: Discussionmentioning

confidence: 99%

Acute Cardiac Tamponade in a 58-Year-Old Male with Poststreptococcal Glomerulonephritis

Bottinor

Fronk

Sadruddin

et al. 2016

Methodist DeBakey Cardiovascular Journal

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A 58-year-old male with diabetes and chronic kidney disease presented with a history of malaise, fatigue, and sore throat. He also had experienced intermittent nausea, vomiting, and diarrhea over the prior 2 weeks and reported subjective fevers and chills. Physical examination was unremarkable. Basic metabolic panel demonstrated acute kidney injury (AKI).The patient was administered intravenous saline. A renal ultrasound demonstrated normal anatomy, and Clostridium difficile antigen was negative. He was started on ceftriaxone and metronidazole for bacterial intestinal overgrowth. Emesis and diarrhea improved after 24 hours of antibiotics; however, renal function continued to worsen. The patient developed volume overload and ultimately required hemodialysis. Transthoracic echocardiogram showed low normal left ventricular systolic function with a trivial pericardial effusion. Urinalysis revealed proteinuria, hematuria, and pyuria. Urine culture was negative. Complement 3 level was low at 47.6 mg/dL (lower limit 90 mg/dL). Complement 4 level was normal. Both erythrocyte sedimentation rate and C-reactive protein were markedly elevated. Antinuclear antibody, antineutrophil cytoplasmic antibody, anti-double-stranded DNA, anti-Ro, anti-La, and antiglomerular basement membrane antibody were negative. Serum protein electrophoresis and urine protein electrophoresis were negative. Creatinine kinase was within normal limits. Hepatitis B and C antibodies were nonreactive, as were HIV antibodies, rheumatoid factor, and cryoglobulins. Serum IgA was 582 mg/dL (upper limit 400 mg/dL) and IgG was 3190 mg/ dL (upper limit 1523 mg/dL). Antistreptolysin O titer was 2484 IU/mL (upper limit of normal 200 IU/mL). The patient was diagnosed with poststreptococcal glomerulonephritis and continued to tolerate dialysis well. Before discharge, the patient developed intractable hiccups. Chest X-ray revealed only resolving pulmonary edema. He was discharged with plans for outpatient chest and abdominal computed tomography (CT) to further evaluate his hiccups.The following day, he presented to the emergency department with acute dyspnea after routine hemodialysis. He had tachypnea and hypoxia that responded to supplemental oxygen. Systolic blood pressure decreased by 10 mm Hg with inspiration. Chest CT demonstrated a moderate pericardial effusion. A repeat transthoracic echocardiogram (online video) showed a pericardial effusion with right atrial and right ventricular diastolic collapse. The patient underwent urgent pericardiocentesis with removal of 700 mL of sanguineous fluid. Bacterial, fungal, mycobacterial cultures, and cytology were negative. His blood urea nitrogen was 39 mg/dL on re-presentation to the hospital. Nine months later, the patient has had no recurrence of pericardial effusion. He has recovered kidney function and no longer requires hemodialysis. DiscussionPericarditis in conjunction with nephritis presents as an interesting clinical picture, leading one to consider a robust list of differential diagnoses that includes autoim...

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Bacterial infection–related glomerulonephritis in adults

Cited by 225 publications

References 105 publications

Repeated acute kidney injury associated with Mycobacterium gordonae infection

Repeated acute kidney injury associated with Mycobacterium gordonae infection

American Society of Nephrology Quiz and Questionnaire 2012

Acute Cardiac Tamponade in a 58-Year-Old Male with Poststreptococcal Glomerulonephritis

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