Methicillin-resistant Staphylococcus aureus (MRSA) infection in glomerulonephritis - a novel hazard emerging on the horizon

Kobayashi, Masahide; Kôyama, Akio

doi:10.1093/ndt/13.12.2999

Cited by 21 publications

(23 citation statements)

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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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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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“…Immunofluorescence revealed glomerular deposits, especially of IgA, with IgG and C3. 2 Yoh et al 4 observed that the frequency of T cells expressing several TCRV s among peripheral lymphocytes was high in MRSA-associated nephritis. Staphylococcal enterotoxins are known to stimulate the proliferation of resting T cells and are called superantigens, 6 and they markedly activate T cells and the release of T-cell-derived cytokines.…”

Section: Discussionmentioning

confidence: 99%

Glomerulonephritis induced by methicillin-sensitive Staphylococcus aureus infection

Handa

Ono

Watanabe

et al. 2003

Clinical and Experimental Nephrology

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A 57-year-old woman developed exacerbation of atopic dermatitis, fever, and nephrotic syndrome with microscopic hematuria. By bacteriological study, methicillin-sensitive Staphylococcus aureus (MSSA) was detected from each culture of pharyngeal mucus, stool, and blood samples. Renal biopsy specimens showed endocapillary proliferative glomerulonephritis with massive IgA deposition in the mesangium and along the capillary loops. After antistaphylococcal therapy with antibiotics, MSSA was negative for each culture and urinary protein decreased. Nine months after the first renal biopsy, a re-biopsy was performed, which revealed apparent disappearance of both endocapillary cell proliferation and IgA deposition. It is known that methicillin-resistant S. aureus (MRSA) infection causes glomerulonephritis through T-cell stimulation by superantigen presented by MRSA. The present results suggest that not only MRSA but also MSSA can cause this type of glomerulonephritis.

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“…In 1995, Koyama’s group [6, 7, 8]reported a new type of glomerulonephritis occurring during the course of MRSA infection. They proposed that this new type be called superantigen-related glomerulonephritis (SARN), because the enterotoxin of MRSA was identified to act as a superantigen in the pathogenesis of glomerulonephritis following MRSA infection.…”

Section: Discussionmentioning

confidence: 99%

“…Another important clinical feature is that MRSA infection often persists for longer periods, since most antibiotics are ineffective. Prolonged septicemia is an important precondition for the development of glomerulonephritis [6, 7, 8]. With increasing numbers of MRSA infection, MRSA-associated glomerulonephritis has been found in our hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Bacterial endocarditis [2, 3]and infected ventriculo-jugular shunt [4, 5]had been two main causes of the disease. Recently, Koyama and coworkers [6, 7, 8] found a new type of glomerulonephritis following methicillin-resistant Staphylococcus aureus (MRSA) infection. This type has a different character from the classical type of glomerulonephritis that follows staphylococcal infection, and a unique mechanism is thought to be involved in the process of acquiring this glomerulonephritis.…”

Section: Introductionmentioning

confidence: 99%

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Effective Antibiotic Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i>-Associated Glomerulonephritis

Nagaba

Hiki

Aoyama

et al. 2002

Nephron

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Background: A new type of glomerulonephritis following a methicillin-resistant Staphylococcus aureus (MRSA) infection has been reported. The purpose of this study is to elucidate the clinicopathological features and the responsiveness to treatment of the disease. Methods: We studied the treatment of 8 patients with glomerulonephritis related to MRSA infection. We observed the eight cases and analyzed clinical features, laboratory findings and histopathological data. Results: On admission, all patients had no renal abnormalities. One to four months after suffering from MRSA infection, severe proteinuria and hematuria developed. Renal biopsy specimens revealed moderate to severe mesangial proliferative glomerulonephritis with various degrees of crescent formation. Immunofluorescence studies showed IgA and C3. Antibiotic therapy was performed in six cases, resulting in successfully reducing the proteinuria in parallel with the decreased activity of MRSA infection in five cases. The other 2 cases received corticosteroid treatment after complete cessation of MRSA infection, but they had a relapse of MRSA infection and later died from sepsis. Conclusions: These results suggested that MRSA-associated glomerulonephritis might respond to antibiotic treatment in most cases. This also indicated that special care must be taken in the application of steroid therapy for the glomerulonephritis with crescents, even though the MRSA infection has gone into an inactive state.

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Methicillin-resistant Staphylococcus aureus (MRSA) infection in glomerulonephritis - a novel hazard emerging on the horizon

Cited by 21 publications

References 0 publications

Staphylococcus Infection-Associated Glomerulonephritis Mimicking IgA Nephropathy

Staphylococcus Infection-Associated Glomerulonephritis Mimicking IgA Nephropathy

Glomerulonephritis induced by methicillin-sensitive Staphylococcus aureus infection

Effective Antibiotic Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i>-Associated Glomerulonephritis

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