The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits

Kitamura, Mineaki; Almaani, Salem; Challa, Bindu; Doraiswamy, Mohankumar; Ayoub, Isabelle; Biederman, Laura; Parikh, Samir; Molovic-Kokovic, Ana; Benedict, Jason; Mhaskar, Nilesh; Khitan, Zeid; Brodsky, Sergey V.; Nádasdy, Tibor; Satoskar, Anjali A.

doi:10.1016/j.ekir.2022.12.024

Cited by 2 publications

(3 citation statements)

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“…For the four previously unpublished cases of Bartonella IE-associated GN from our institution, we present detailed clinico-pathologic data. For comparison, we have also present data from the native kidney biopsies of culture-proven IE-related GN caused by bacteria other than Bartonella, that were diagnosed at the Ohio State University Wexner Medical Center from 2004 to 2022 ( 7 , 15 ).…”

Section: Methodsmentioning

confidence: 99%

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Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis – our experience and a pooled analysis

Kitamura,

Dasgupta,

Henricks

et al. 2024

Front. Nephrol.

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BackgroundAlthough Staphylococcus aureus is the leading cause of acute infective endocarditis (IE) in adults, Bartonella spp. has concomitantly emerged as the leading cause of “blood culture-negative IE” (BCNE). Pre-disposing factors, clinical presentation and kidney biopsy findings in Bartonella IE-associated glomerulonephritis (GN) show subtle differences and some unique features relative to other bacterial infection-related GNs. We highlight these features along with key diagnostic clues and management approach in Bartonella IE-associated GN.MethodsWe conducted a pooled analysis of 89 cases of Bartonella IE-associated GN (54 published case reports and case series; 18 published conference abstracts identified using an English literature search of several commonly used literature search modalities); and four unpublished cases from our institution.ResultsBartonella henselae and Bartonella quintana are the most commonly implicated species causing IE in humans. Subacute presentation, affecting damaged native and/or prosthetic heart valves, high titer anti-neutrophil cytoplasmic antibodies (ANCA), mainly proteinase-3 (PR-3) specificity, fastidious nature and lack of positive blood cultures of these Gram-negative bacilli, a higher frequency of focal glomerular crescents compared to other bacterial infection-related GNs are some of the salient features of Bartonella IE-associated GN. C3-dominant, but frequent C1q and IgM immunofluorescence staining is seen on biopsy. A “full-house” immunofluorescence staining pattern is also described but can be seen in IE –associated GN due to other bacteria as well. Non-specific generalized symptoms, cytopenia, heart failure and other organ damage due to embolic phenomena are the highlights on clinical presentation needing a multi-disciplinary approach for management. Awareness of the updated modified Duke criteria for IE, a high index of suspicion for underlying infection despite negative microbiologic cultures, history of exposure to animals, particularly infected cats, and use of send-out serologic tests for Bartonella spp. early in the course of management can help in early diagnosis and initiation of appropriate treatment.ConclusionDiagnosis of IE-associated GN can be challenging particularly with BCNE. The number of Bartonella IE-associated GN cases in a single institution tends to be less than IE due to gram positive cocci, however Bartonella is currently the leading cause of BCNE. We provide a much-needed discussion on this topic.

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Section: Methodsmentioning

confidence: 99%

“…Diagnostic biopsy evaluation at our institution was done as described previously ( 7 , 15 ). The time from onset of symptoms to the biopsy was estimated from the descriptions provided in the published manuscripts or from the pathology reports (for cases from our institution).…”

Section: Methodsmentioning

confidence: 99%

Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis – our experience and a pooled analysis

Kitamura,

Dasgupta,

Henricks

et al. 2024

Front. Nephrol.

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“…Kitamura et al. could successfully categorize 65% of such cases using a range of clinicopathological features, but a substantial subset, which they termed as ‘group X’ (representing 35% of the cases), remained a diagnostic and therapeutic challange due to inconsistent clinicopathological characteristics [ 3 ].…”

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confidence: 99%

Crescents in IgA nephropathy: making the step from prognostic risk factor to therapy target

Stefan

2023

Renal Failure

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The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits

Cited by 2 publications

References 43 publications

Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis – our experience and a pooled analysis

Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis – our experience and a pooled analysis

Crescents in IgA nephropathy: making the step from prognostic risk factor to therapy target

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