Clinical, Pathological, and Prognostic Characteristics of Glomerulonephritis Related to Staphylococcal Infection

Abstract

Staphylococcal infection has become a common cause of postinfectious glomerulonephritis in the past 3 decades. Because few investigations focus on this disease, the demographics and clinicopathological features of glomerulonephritis related to staphylococcal infection are not well characterized.We conducted a pooled analysis of published literature in electronic databases and analyzed the clinical features, laboratory findings, and histopathological changes. The patients were divided into 4 groups based on their prognosis: remission, persistent renal dysfunction, end-stage renal disease (ESRD), or death. A logistic regression model was used to identify the determinants of disease outcome.A total of 83 (64 men) patients with glomerulonephritis related to staphylococcal infection from 31 reports were analyzed. The mean age was 58 years (58 ± 17). Majority of the reports originated from Taiwan, Japan, and the United States. Clinical characteristics of the cases were hematuria (82/83), proteinuria (78/83), and acute kidney injury (75/83). Visceral abscesses (26/83) and skin infections (24/83) were the common sites of infection. Methicillin-resistant Staphylococcus aureus was the most common pathogen. The dominant or codominant deposition of IgA or C3 along the glomeruli was an important feature identified by immunofluorescence. There were 19 patients (22.9%) that progressed to dialysis-dependent ESRD. Twelve patients (14.5%) died. A univariate regression analysis indicated that diabetes mellitus (DM) (odds ratio [OR] 2.96; 95% confidence interval [CI] 1.03–8.48; P = 0.04) and age (OR 4.80; 95% CI 1.84–12.53; P = 0.001) were risk factors for ESRD or death. A multivariate regression analysis also revealed that age (OR 4.90; 95% CI 1.82–13.18; P = 0.002) and DM (OR 3.07; 95% CI 0.98–9.59; P = 0.05) were independent risk factors for unfavorable prognosis.Glomerulonephritis related to staphylococcal infection has different features than typical postinfectious glomerulonephritis. The diagnosis of glomerulonephritis related to staphylococcal infection relies on immunofluorescence and electron microscopy findings. Age and DM are independent risk factors of poor prognosis for glomerulonephritis related to staphylococcal infection.

The Impact of Diabetes on Acute Post-Infectious Glomerulonephritis in Rats: An Experimental Study with Literature Review

“…Microbial populations of Candida albicans and Staphylococcus aureus were found to be higher and more persistent in diabetic rats [9,10]; in contrast, renal enterococcal populations were similarly sustained in both diabetic and control rats. Neither the duration of the diabetic state nor weight loss was found to be a contributing factor.…”

Clinicopathologic Features of Infection-Related Glomerulonephritis with IgA Deposits: a French Nationwide Study

“…This finding is comparable to previous results reporting that 75% to 86% of the patients are male with a mean age of 55 to 65 years. 9,10,12,[16][17][18][19][20] It must be noted that the youngest of our patients is a 5-year-old boy, indicating that IRGN-IgA, although rarely reported, can be observed in pediatric patients. In this case and in other reported pediatric cases, children with Staphylococcus-related GN had the same presentation as adults, namely proteinuria and renal function impairment.…”

“…[5][6][7][8] Post-staphylococcal glomerulonephritis (GN) can histologically appear with two patterns: one resembling acute poststreptococcal glomerulonephritis, due to Staphylococcus aureus infection and mostly associated with diabetes mellitus, neoplasia or alcoholism; the other with a membranoproliferative glomerulonephritis pattern in Staphylococcus epidermidis infection in patients with atrio-ventricular shunts. 8,9 However, a new presentation was first reported in 1980 by Spector et al and described in 2003 by Nasr et al in 5 patients with type 2 diabetes, Staphylococcus aureus infection, acute renal failure and histologic exudative endocapillary proliferation with predominant mesangial IgA deposits. 10 Since then, American or Asian teams have reported cases and cohorts of infection-related glomerulonephritis with dominant IgA deposits (IRGN-IgA) or codominant with C3 deposits.…”

Clinical features and outcome of infection-related glomerulonephritis with IgA deposits

“…In our study, endocapillary proliferation (89% vs 23-63% in previous series) made of neutrophils in most cases (81% vs 15 to 63% of the biopsies) was more frequent whereas pure mesangial proliferation was less frequent compared to other studies. 9,10,13,18,19,21 We also noticed differences when we compared histological patterns as classified in acute, subacute and resolving by Haas et al in 2008. 13 The authors reported more resolving and less acute or subacute patterns compared to our cohort, with 15% of acute, 23% of subacute and 62% of resolving GN vs 26%, 63% and 11% respectively in our cohort.…”

“…5−8 Post-staphylococcal glomerulonephritis (GN) can histologically appear with two patterns: one resembling acute poststreptococcal glomerulonephritis, mostly observed in patients with diabetes mellitus, neoplasia or those with chronic alcoholic consumption, infected with Staphylococcus aureus infection; the other corresponding to a membranoproliferative glomerulonephritis pattern in Staphylococcus epidermidis infection of atrio-ventricular shunt. 8,9 A third form was reported in 1980 by Spector et al, and described in 2003 by Nasr et al with 5 cases of type 2 diabetes patients with a Staphylococcus aureus infection, presenting with acute renal failure and histologic exudative endocapillary proliferation with predominant mesangial IgA deposits. 10,11 Since then, American or Asian teams reported cases and cohorts of infection-related glomerulonephritis with dominant IgA deposits (IRGN-IgA) or codominant with C3 deposits.…”