Cytokines and T‐cell responses in superantigen‐related glomerulonephritis following methicillin‐resistant Staphylococcus aureus infection

Yoh, Keigyou; Kobayashi, Masaki; Yamaguchi, Naoto; Hirayama, Kouichi; Ishizu, Tomoko; Kikuchi, Shuichi; Iwabuchi, Satoshi; Muro, Kaori; Nagase, Sohji; Aoyagi, Kazumasa; Kondoh, Makoto; Takemura, Katsumi; Yamagata, Kunihiro; Kôyama, Akio

doi:10.1093/ndt/15.8.1170

Cited by 55 publications

(59 citation statements)

References 14 publications

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“…Superantigens are proteins that may be detected in several pathogenic microbes including Staphylococcus. They are powerful activators of immune systems and stimulate the production of T cells, and induce antibody production including IgA [21,26].…”

Section: Discussionmentioning

confidence: 99%

An unusual case of IgA-dominant postinfectious glomerulonephritis: a case report and review of the literature

Wągrowska-Danilewicz

Danilewicz²,

Fisiak³

et al. 2016

pjp

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We report a case of IgA-dominant postinfectious glomerulonephritis in a 49-yearold man presenting with acute kidney injury, nephrotic range proteinuria and hematuria. He suffered from ischemic heart disease, cardiac insufficiency, mitral regurgitation, tricuspid insufficiency, septal aneurysm and hypertension. Renal biopsy revealed segmental and focal endocapillary and mesangial hypercellularity, and thickening of the glomerular capillary wall. Immunofluorescence showed co-dominant strong coarse granular immunostaining of IgA, IgG and C3 mainly along the glomerular capillary wall. On electron microscopy some large subepithelial hump-shaped deposits were present. In summary, this case demonstrates the presence of a broad spectrum of glomerular histological findings in postinfectious glomerulonephritis.

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Section: Discussionmentioning

confidence: 99%

An unusual case of IgA-dominant postinfectious glomerulonephritis: a case report and review of the literature

Wągrowska-Danilewicz

Danilewicz²,

Fisiak³

et al. 2016

pjp

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“…Autoantibodies were not detected in this case that was also consistent with the cases reported previously (1,(3)(4)(5). In most cases with MRSA-GN reported previously, renal pathology showedmesangial and/or endocapillary proliferative glomerulonephritis with various degrees of crescent formation and tubulointerstitial nephritis (1)(2)(3)(4)(5). The present case also showed mesangial proliferative glomerulonephritis with cellular crescent formation and interstitial nephritis.…”

Section: Case Reportmentioning

confidence: 96%

“…The cases of MRSA-GN may have substantially more varied types of features. It is reported that the prognosis of MRSA-GN is relatively good if the appropriate treatment is administered for the MRSA infection, and if the underlying disease does not worsen (1,2,5). In the present case, we speculate that we could prevent the second deterioration of renal function and subsequent requirement of contiuous HDtherapy if we had completely eradicated MRSA.…”

Section: Case Reportmentioning

confidence: 99%

“…From 1995, cases of superantigen-related glomerulonephritis associated with methicillin-resistant Staphylococcus aureus (MRSA)infection have been reported and it is speculated that the enterotoxins of S. aureus mayserve as superantigens in its pathogenesis (1)(2)(3)(4). We present here a patient who developed glomerulonephritis after MRSA infection which resulted in endstage renal failure even though he received prednisolone pulse therapy and plasmapheresis in addition to administration of vancomycin.…”

Section: Introductionmentioning

confidence: 99%

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Glomerulonephritis after Methicillin-resistant Staphylococcus aureus Infection Resulting in End-stage Renal Failure.

et al. 2001

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A 58-year-old man developed proteinuria and renal dysfunction following pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). Vancomycinwas administered, and prednisolone pulse therapy and plasmapheresis were performed. Subsequently, serum creatinine was decreased. Eight months later, creatinine and CRPwere again elevated, and MRSA was detected. Vancomycinwas again administered and plasmapheresis was performed. However, renal function was not improved and continuous hemodialysis was initiated. This case indicates that complete eradication of MRSA is necessary to treat MRSA-associated glomerulonephritis, and if this is not attained, a permanent loss of renal function occurs. (Internal Medicine 40: 424-427, 2001)

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“…The association of MRSA infection with GN has been well documented in Japan (2)(3)(4)(5)(6)(7)(8)(9). Based primarily on these publications, it appears evident that S. aureus-associated GN is characterized by glomerular IgA deposits; therefore, the renal biopsy findings strongly resemble primary (idiopathic) IgA nephropathy.…”

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confidence: 99%

Staphylococcus Infection-Associated Glomerulonephritis Mimicking IgA Nephropathy

Satoskar

Nadasdy

Plaza

et al. 2006

Clinical Journal of the American Society of Nephrology

130

152

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The association of methicillin-resistant Staphylococcus aureus (MRSA) infection with glomerulonephritis (GN) has been well documented in Japan but not in North America. Recently, eight renal biopsies with IgA-predominant or -codominant GN from eight patients with underlying staphylococcal infection, but without endocarditis, were observed at a single institution in a 12-mo period. Renal biopsies were worked up by routinely used methodologies. Eight cases of primary IgA nephropathy were used as controls. Five patients had MRSA infection, one had methicillin-resistant S. epidermidis (MRSE) infection, and two had methicillin-sensitive S. aureus infection. Four patients became infected after surgery; two patients were diabetic and had infected leg ulcers. All patients developed acute renal failure, with active urine sediment and severe proteinuria. Most renal biopsies showed only mild glomerular hypercellularity. Two biopsies had prominent mesangial and intracapillary hypercellularity; one of them (the MRSE-associated case) had large glomerular hyalin thrombi. This patient also had a positive cryoglobulin test. Rare glomerular hyalin thrombi were noted in two other cases. Immunofluorescence showed IgA pre-or codominance in all biopsies. Electron microscopy revealed mesangial deposits in all cases. Five biopsies had rare glomerular capillary deposits as well. In the MRSE-associated GN, large subendothelial electron-dense deposits were present. These cases demonstrate that staphylococcal (especially MRSA) infection-associated GN occurs in the US as well, and a rising incidence is possible. It is important to differentiate a Staphylococcus infection-associated GN from primary IgA nephropathy to avoid erroneous treatment with immunosuppressive medications.Clin J Am Soc Nephrol 1: 1179 -1186, 2006. doi: 10.2215/CJN.01030306 S taphylococci are widespread pathogens and their frequent antibiotic resistance makes treatment difficult. Occasional episodes of glomerulonephritis (GN) after Staphylococcus epidermidis bacteremia in patients with ventriculoatrial or ventriculojugular shunts and after S. aureus bacteriemia secondary to endocarditis are well documented and are discussed in most nephrology and renal pathology textbooks. These Staphylococcus infection-related glomerulonephritides are associated with glomerular immune complex deposits, which contain complement (mainly C3) IgG and sometimes IgM. Much less is known about GN associated with methicillinresistant S. aureus (MRSA), and methicillin-resistant S. epidermidis (MRSE), which are now endemic in most hospitals. A growing number of community-acquired infections are also reported (1).The association of MRSA infection with GN has been well documented in Japan (2-9). Based primarily on these publications, it appears evident that S. aureus-associated GN is characterized by glomerular IgA deposits; therefore, the renal biopsy findings strongly resemble primary (idiopathic) IgA nephropathy. The IgA-containing immune complexes are mainly deposited in the mesangium, but they ...

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Cytokines and T‐cell responses in superantigen‐related glomerulonephritis following methicillin‐resistant Staphylococcus aureus infection

Abstract: These results suggest that T cells activated by MRSA-derived staphylococcal enterotoxins and subsequent production of cytokines may play an important role in the pathogenesis of MRSA-associated GN.

Cited by 55 publications

References 14 publications

An unusual case of IgA-dominant postinfectious glomerulonephritis: a case report and review of the literature

An unusual case of IgA-dominant postinfectious glomerulonephritis: a case report and review of the literature

Glomerulonephritis after Methicillin-resistant Staphylococcus aureus Infection Resulting in End-stage Renal Failure.

Staphylococcus Infection-Associated Glomerulonephritis Mimicking IgA Nephropathy

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