The Pulsing Paradox: Successful Steroid Therapy in Infection-Related Glomerulonephritis

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Aug 19

PMID 39156284

Authors

Ananya Anantharaman

Viswanathan Pandurangan

Devasena Srinivasan

Divya Joyce

Subalakshmi Balasubramanian

Affiliations

Soon will be listed here.

Abstract

The patterns of infection-related glomerulonephritis (IRGN) are rapidly changing in terms of age at presentation and sources of infection. The existing literature on the use of steroids in IRGN is inconsistent. A diabetic male in his sixties presented with features of anasarca, bilateral flank pain, and acute pulmonary edema. He had a non-healing ulcer over his right leg, with pus culture showing growth of methicillin-resistant (MRSA). Computed tomography (CT) of the kidneys, ureter, and bladder (KUB) showed features of bilateral pyelonephritis. The patient went on to develop acute renal failure and eventually required hemodialysis. A renal biopsy was performed, and features of IRGN with crescents were noted. Considering the presence of crescents in renal biopsy, a trial of steroids was given under antibiotic cover, which resulted in a near-complete resolution of renal failure.

References

Nasr S, Markowitz G, Whelan J, Albanese J, Rosen R, Fein D . IgA-dominant acute poststaphylococcal glomerulonephritis complicating diabetic nephropathy. Hum Pathol. 2003; 34(12):1235-41. DOI: 10.1016/s0046-8177(03)00424-6. View

Nasr S, Radhakrishnan J, DAgati V . Bacterial infection-related glomerulonephritis in adults. Kidney Int. 2013; 83(5):792-803. DOI: 10.1038/ki.2012.407. View

Kapadia A, Panda M, Fogo A . Postinfectious glomerulonephritis: Is there a role for steroids?. Indian J Nephrol. 2011; 21(2):116-9. PMC: 3132331. DOI: 10.4103/0971-4065.82141. View

Nagaba Y, Hiki Y, Aoyama T, Sano T, Matsuo T, Shimizu T . Effective antibiotic treatment of methicillin-resistant Staphylococcus aureus-associated glomerulonephritis. Nephron. 2002; 92(2):297-303. DOI: 10.1159/000063309. View

Soni S, Gowrishankar S, Kishan A, Raman A . Non diabetic renal disease in type 2 diabetes mellitus. Nephrology (Carlton). 2007; 11(6):533-7. DOI: 10.1111/j.1440-1797.2006.00681.x. View

Sakthirajan R, Dhanapriya J, Nagarajan M, Dineshkumar T, Balasubramaniyan T, Gopalakrishnan N . Crescentic infection related glomerulonephritis in adult and its outcome. Saudi J Kidney Dis Transpl. 2018; 29(3):623-629. DOI: 10.4103/1319-2442.235169. View

Khalighi M, Wang S, Henriksen K, Bock M, Keswani M, Meehan S . Revisiting post-infectious glomerulonephritis in the emerging era of C3 glomerulopathy. Clin Kidney J. 2016; 9(3):397-402. PMC: 4886922. DOI: 10.1093/ckj/sfw032. View

Arivazhagan S, Rajasekar D, Gopalakrishnan N, Sakthirajan R, Dhanapriya J, Kumar T . Clinicopathological profile and outcome of adult infection-related glomerulonephritis: A prospective follow-up study. Natl Med J India. 2021; 33(5):260-264. DOI: 10.4103/0970-258X.317465. View

Baikunje S, Vankalakunti M, Nikith A, Srivatsa A, Alva S, Kamath J . Post-infectious glomerulonephritis with crescents in adults: a retrospective study. Clin Kidney J. 2016; 9(2):222-6. PMC: 4792622. DOI: 10.1093/ckj/sfv147. View

10.

Chen Y, Wen Y . Favorable outcome of crescentic IgA nephropathy associated with methicillin-resistant Staphylococcus aureus infection. Ren Fail. 2011; 33(1):96-100. DOI: 10.3109/0886022X.2010.541576. View

11.

John E, Roy S, Eapen J, Alam R, Varughese S . When to Suspect Non-diabetic Kidney Disease in a Diabetic Patient?. Cureus. 2022; 14(8):e28091. PMC: 9484782. DOI: 10.7759/cureus.28091. View

12.

Kurien A, Jansi Prema K, Gopalakrishnan N . Infection-related glomerulonephritis is the most common finding in renal biopsies in the very elderly in India. Clin Kidney J. 2021; 14(1):454-456. PMC: 7857827. DOI: 10.1093/ckj/sfz162. View

13.

Nasr S, Markowitz G, Stokes M, Said S, Valeri A, DAgati V . Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature. Medicine (Baltimore). 2008; 87(1):21-32. DOI: 10.1097/md.0b013e318161b0fc. View

14.

Arivazhagan S, Lamech T, Myvizhiselvi M, Arumugam V, Alavudeen S, Dakshinamoorthy S . Efficacy of Corticosteroids in Infection-Related Glomerulonephritis-A Randomized Controlled Trial. Kidney Int Rep. 2022; 7(10):2160-2165. PMC: 9546739. DOI: 10.1016/j.ekir.2022.07.163. View

15.

Majumdar A, Chowdhary S, Ferreira M, Hammond L, Howie A, Lipkin G . Renal pathological findings in infective endocarditis. Nephrol Dial Transplant. 2000; 15(11):1782-7. DOI: 10.1093/ndt/15.11.1782. View

16.

Montseny J, Meyrier A, KLEINKNECHT D, Callard P . The current spectrum of infectious glomerulonephritis. Experience with 76 patients and review of the literature. Medicine (Baltimore). 1995; 74(2):63-73. DOI: 10.1097/00005792-199503000-00001. View

17.

Keller C, Andrassy K, Waldherr R, Ritz E . Postinfectious glomerulonephritis--is there a link to alcoholism?. Q J Med. 1994; 87(2):97-102. View

18.

Dhanapriya J, Balasubramaniyan T, Maharajan S, Dineshkumar T, Sakthirajan R, Gopalakrishnan N . IgA-dominant Infection-related Glomerulonephritis in India: A Single-center Experience. Indian J Nephrol. 2017; 27(6):435-439. PMC: 5704407. DOI: 10.4103/ijn.IJN_337_16. View

19.

Glassock R, Alvarado A, Prosek J, Hebert C, Parikh S, Satoskar A . Staphylococcus-related glomerulonephritis and poststreptococcal glomerulonephritis: why defining "post" is important in understanding and treating infection-related glomerulonephritis. Am J Kidney Dis. 2015; 65(6):826-32. DOI: 10.1053/j.ajkd.2015.01.023. View