Glomerulonephritis induced by methicillin-sensitive Staphylococcus aureus infection

Handa, Tomohiro; Ono, Takahiko; Watanabe, Hidenobu; Takeda, Tomoki; Muso, Eri; Kita, Toru

doi:10.1007/s10157-003-0240-4

Cited by 31 publications

(22 citation statements)

References 10 publications

(8 reference statements)

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“…We termed this novel immunopathologic form of APIGN ‘IgA-dominant APIGN’ [6]. To date, 49 cases of IgA-dominant APIGN have been reported in the English literature, 24 of which were from our group [3,6,7,8,9,10,11,12,13,14]. Most of the reports originated from the US, Japan and Taiwan.…”

Section: Introductionmentioning

confidence: 99%

IgA-Dominant Postinfectious Glomerulonephritis: A New Twist on an Old Disease

2011

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IgA-dominant acute postinfectious glomerulonephritis (APIGN) is an increasingly recognized morphologic variant of APIGN, particularly in the elderly. In contrast to classic APIGN, in which there is typically glomerular deposition of IgG and C3 or C3 only, IgA is the sole or dominant immunoglobulin in IgA-dominant APIGN. Because the vast majority of reported cases occur in association with staphylococcal infections, the alternative designation ‘IgA-dominant acute poststaphylococcal glomerulonephritis’ has been applied. Diabetes is a major risk factor, likely reflecting the high prevalence of staphylococcal infection in diabetics, particularly involving skin. Patients typically present with severe renal failure, proteinuria and hematuria. Prognosis is guarded with less than a fifth of patients fully recovering renal function. This variant of APIGN must be distinguished from IgA nephropathy. Features that favor IgA-dominant APIGN over IgA nephropathy include initial presentation in older age or in a diabetic patient, acute renal failure, intercurrent culture-documented staphylococcal infection, hypocomplementemia, diffuse glomerular endocapillary hypercellularity with prominent neutrophil infiltration on light microscopy, stronger immunofluorescence staining for C3 than IgA, and the presence of subepithelial humps on electron microscopy. The pathogenetic mechanism of selective IgA deposition in patients with poststaphylococcal glomerulonephritis likely involves specific host responses to the inciting pathogen.

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Section: Introductionmentioning

confidence: 99%

IgA-Dominant Postinfectious Glomerulonephritis: A New Twist on an Old Disease

2011

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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

133

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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“…Referring to this report, we started the use of prednisolone at the same dose. We reviewed the previously published reports of patients with IgA-dominant PIGN who were treated with steroids (12,(18)(19)(20)(21); the clinical features of 9 reported patients (including the present case) are shown in Table 2. Of note, steroids were used only in patients with severe renal diseases including RPGN or nephrotic syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…To date, approximately 80 cases of IgA-dominant PIGN have been reported (1,2,4,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). To the best of our knowledge, only 3 cases of IgA-dominant PIGN caused by E. coli infection have been reported (4,7).…”

Section: Discussionmentioning

confidence: 99%

IgA-dominant Postinfectious Glomerulonephritis Associated with <i>Escherichia coli</i> Infection Caused by Cholangitis

et al. 2014

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A 76-year-old man with a history of type 2 diabetes mellitus was admitted with cholangitis caused by cholangiocarcinoma. Cholangitis with Escherichia coli (E. coli) bacteremia recurred due to the unstable bile drainage. At 1 month after recurrence, rapidly progressive glomerulonephritis with nephrotic syndrome was manifested. Renal biopsy findings were consistent with immunoglobulin A (IgA)-dominant postinfectious glomerulonephritis (PIGN). After ensuring that the recurrent cholangitis was controlled by drainage and antibiotic therapy, oral prednisolone was initiated, and the patient's renal function and proteinuria subsequently gradually improved. This is the first case report of IgA-dominant PIGN associated with cholangitis caused by E. coli infection.

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Glomerulonephritis induced by methicillin-sensitive Staphylococcus aureus infection

Cited by 31 publications

References 10 publications

IgA-Dominant Postinfectious Glomerulonephritis: A New Twist on an Old Disease

IgA-Dominant Postinfectious Glomerulonephritis: A New Twist on an Old Disease

Staphylococcus Infection-Associated Glomerulonephritis Mimicking IgA Nephropathy

IgA-dominant Postinfectious Glomerulonephritis Associated with <i>Escherichia coli</i> Infection Caused by Cholangitis

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