IgA dominant postinfectious glomerulonephritis: Report of two cases

Rajakumar, V; Mohamed, Safwan; Kurien, Abraham; Fernando, M Edwin

doi:10.4103/0971-4065.132020

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…Nevertheless, the association between diabetes and IRGN-IgA is inconstant, reported in 8 to 55 % of patients in previous studies and in 44 % of patients in our study. 10,12,[16][17][18][22][23][24] As seen since the first report, Staphylococcus represents the most frequent germ (78% in our study, 60 to 100% in other studies). 10,12,17,18,24 A higher frequency of MRSA was observed in Asian and American studies (50 to 60%) compared to our cohort (15%).…”

Section: Discussionsupporting

confidence: 74%

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

Miquelestorena-Standley

Jaulerry

Machet

et al. 2020

Preprint

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Background: Infection-related glomerulonephritis with IgA deposits (IRGN-IgA) is a rare disease but it is increasingly reported in the literature. Data regarding epidemiology and outcome are lacking, especially in Europe. We aimed to assess the clinical, pathologic and outcome data of IRGN-IgA. Methods: Clinical and outcome data from patients from 11 French centers over the 2007-2017 period were collected retrospectively. We reviewed pathologic patterns and immunofluorescence of renal biopsies and evaluated C4d expression in IRGN-IgA. We analyzed the correlation between histological presentation and outcome. Results: Twenty-seven patients (23 men, mean age: 62±15 years) were included. Twenty-one (78%) had Staphylococcus aureus infection and twelve (44%) were diabetic. At the time of biopsy, 95.2% had haematuria, 48.1% had a serum creatinine level of >4 mg/dL, and 16% had hypocomplementemia. The most common pathologic presentation included mesangial (88.9%) and endocapillary proliferative glomerulonephritis (88.9%) with interstitial fibrosis and tubular atrophy (IF/TA) (85.1%). Diffuse and global glomerular C4d expression was found in 17.8%, mostly in biopsies with acute or subacute patterns, and was associated with a short delay between infection and renal biopsy compared to segmental and focal staining. After median follow-up of 13.2 months, 23.1% died, 46.2% had persistent renal dysfunction and 15.4% reached end-stage renal disease. Renal outcome was correlated to IF/TA severity. Conclusions: Infection-related glomerulonephritis with IgA deposits is usually associated with Staphylococcus infections and mainly affects adult men. This entity has a poor prognosis which is correlated to interstitial fibrosis and tubular atrophy severity.

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Section: Discussionsupporting

confidence: 74%

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

Miquelestorena-Standley

Jaulerry

Machet

et al. 2020

Preprint

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“…IgA dominant PIGN is a relatively recently recognized entity, and it is important to distinguish it from IgA nephropathy, with which it can easily be confused [9,12,13,14,15,16,17,18,19]. The most frequent histological pattern of glomerular injury in IgA-dominant PIGN is endocapillary and exudative glomerulonephritis, identical to that seen in poststreptococcal glomerulonephritis; however, pure mesangial proliferative glomerulonephritis was described in 33% of reported patients with this disease [6].…”

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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“…One study was excluded due to the presence of idiotypic IgAN combined with infecion [11]; 3 references were excluded because of publication type (i.e., review) [2,12,13]; and 3 studies were excluded due to unavailable relevant original data [14,15,16]. Finally, 28 eligible reports concerning IgA-dominant IAGN were obtained and reviewed again based on the exclusion criteria [4,5,6,7,8,9,10,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. …”

Section: Methodsmentioning

confidence: 99%

Clinicopathologic Features of IgA-Dominant Infection-Associated Glomerulonephritis: A Pooled Analysis of 78 Cases

Bu¹,

Li²,

Duan³

et al. 2015

Am J Nephrol

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Backgrounds: IgA-dominant infection-associated glomerulonephritis (IgA-dominant IAGN) is a unique form of glomerulonephritis. There are numerous case reports in the literature. However, the risk factors, treatment approach, and outcomes of the disease are not clearly characterized. Methods: We completed a pooled analysis based on published literature. Clinical features, laboratory findings, and histopathological changes were analyzed. A logistic regression model was employed to identify the determinants of disease outcome, for example, end-stage renal disease (ESRD) or death. Results: Seventy-eight patients with IgA-dominant IAGN from 28 reports were analyzed. All of these patients showed granular IgA deposits predominantly along the glomerular peripheral capillary walls using immunofluorescence and majority showed subepithelial ‘hump-shaped' electron-dense deposits using electron microscopy. The majority of patients had hematuria (76/78), proteinuria (75/78), acute kidney injury (AKI) (66/78) and hypocomplementemia (43/75) without a previous history of renal disease. All of the patients had clinical infections at the time of presentation. Skin infections (19/78) and visceral abscesses (15/78) were frequently encountered, and staphylococcus was the most common pathogen. After treatment with antibiotics and/or supportive therapy, the renal function of 42 patients (54.5%) improved, 9 patients (11.7%) had persistent renal dysfunction, 15 patients (19.5%) progressed to ESRD, and 11 patients (14.3%) died. A multivariate regression analysis revealed that age (odds ratio [OR], 30.71; 95% confidence interval [CI], 2.53-373.07; p = 0.007) and diabetes mellitus (DM) (OR, 16.65; 95% CI, 1.18-235.84; p = 0.038) were independent risk factors for ESRD or death. Conclusions: IgA-dominant IAGN has unique clinicopathological manifestations and treatment responses. Age and DM are independent risk factors associated with an unfavorable prognosis for IgA-dominant IAGN.

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IgA dominant postinfectious glomerulonephritis: Report of two cases

Cited by 10 publications

References 14 publications

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

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

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

Clinicopathologic Features of IgA-Dominant Infection-Associated Glomerulonephritis: A Pooled Analysis of 78 Cases

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