Staphylococcus-associated glomerulonephritis in adults
- Samih H Nasr, MD
Samih H Nasr, MD
- Associate Professor of Laboratory Medicine and Pathology
- College of Medicine, Mayo Clinic
- Jai Radhakrishnan, MD, MS
Jai Radhakrishnan, MD, MS
- Professor of Medicine
- Columbia University Medical Center
- Vivette D D'Agati, MD
Vivette D D'Agati, MD
- Professor of Pathology
- Columbia University
- College of Physicians and Surgeons
- Section Editors
- Lee A Hebert, MD
Lee A Hebert, MD
- Section Editor — Glomerular Diseases
- Professor of Medicine
- Ohio State University
- Wexner College of Medicine and Public Health
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
The term postinfectious glomerulonephritis has primarily referred to poststreptococcal glomerulonephritis. This is still appropriate in children, but in adults, as described below, Staphylococcus-associated glomerulonephritis (previously referred to as post-staphylococcal glomerulonephritis) may be as or more common.
This topic will review Staphylococcus-associated glomerulonephritis in adults. Other causes of infection-related glomerulonephritis, including poststreptococcal glomerulonephritis and glomerulonephritis associated with endocarditis or with viral, fungal, protozoal, or parasitic infections, are discussed elsewhere. (See "Poststreptococcal glomerulonephritis" and "Renal disease in the setting of infective endocarditis or an infected ventriculoatrial shunt" and "Overview of renal disease associated with hepatitis C virus infection" and "Renal disease associated with hepatitis B virus infection" and "Overview of kidney disease in HIV-positive patients" and "Clinical presentation, classification, and causes of membranoproliferative glomerulonephritis", section on 'Infections' and "Schistosomiasis and glomerular disease" and "Clinical manifestations and diagnosis of echinococcosis", section on 'Other organs'.)
Proposed general terms for glomerulonephritis induced by infections mentioned in the preceding section are infection-associated or infection-related glomerulonephritis . The most commonly used term for Streptococcus-related disease is poststreptococcal glomerulonephritis because the renal disease typically begins after the usually pharyngeal or skin infection has either resolved spontaneously or has been effectively treated.
By contrast, most of the other causes of bacterial infection-associated glomerulonephritis, including that due to Staphylococcus infection, occur when the patient is still infected. Thus, we prefer the term Staphylococcus-associated glomerulonephritis to distinguish it from glomerulonephritis that can develop when the infection is no longer active (eg, poststreptococcal glomerulonephritis). (See "Poststreptococcal glomerulonephritis".)
Staphylococcus-associated glomerulonephritis is an immune complex-mediated disease . The antigen component of the immune complex is derived from the infective agent, similar to poststreptococcal glomerulonephritis. (See "Poststreptococcal glomerulonephritis", section on 'Pathogenesis'.)
- Nadasdy T, Hebert LA. Infection-related glomerulonephritis: understanding mechanisms. Semin Nephrol 2011; 31:369.
- Nasr SH, Radhakrishnan J, D'Agati VD. Bacterial infection-related glomerulonephritis in adults. Kidney Int 2013; 83:792.
- Yousif Y, Okada K, Batsford S, Vogt A. Induction of glomerulonephritis in rats with staphylococcal phosphatase: new aspects in post-infectious ICGN. Kidney Int 1996; 50:290.
- Fujigaki Y, Yousif Y, Morioka T, et al. Glomerular injury induced by cationic 70-kD staphylococcal protein; specific immune response is not involved in early phase in rats. J Pathol 1998; 184:436.
- Koyama A, Sharmin S, Sakurai H, et al. Staphylococcus aureus cell envelope antigen is a new candidate for the induction of IgA nephropathy. Kidney Int 2004; 66:121.
- Koyama A, Kobayashi M, Yamaguchi N, et al. Glomerulonephritis associated with MRSA infection: a possible role of bacterial superantigen. Kidney Int 1995; 47:207.
- Sharmin S, Shimizu Y, Hagiwara M, et al. Staphylococcus aureus antigens induce IgA-type glomerulonephritis in Balb/c mice. J Nephrol 2004; 17:504.
- Shimizu Y, Sakurai H, Hirayama K, et al. Staphylococcal cell membrane antigen, a possible antigen in post-methicillin resistant Staphylococcus aureus (MRSA) infection nephritis and IgA nephropathy, exhibits high immunogenic activity that is enhanced by superantigen. J Nephrol 2005; 18:249.
- Nasr SH, Markowitz GS, Stokes MB, et al. Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature. Medicine (Baltimore) 2008; 87:21.
- Montseny JJ, Meyrier A, Kleinknecht D, Callard P. The current spectrum of infectious glomerulonephritis. Experience with 76 patients and review of the literature. Medicine (Baltimore) 1995; 74:63.
- Nasr SH, Fidler ME, Valeri AM, et al. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol 2011; 22:187.
- Wen YK, Chen ML. The significance of atypical morphology in the changes of spectrum of postinfectious glomerulonephritis. Clin Nephrol 2010; 73:173.
- Moroni G, Pozzi C, Quaglini S, et al. Long-term prognosis of diffuse proliferative glomerulonephritis associated with infection in adults. Nephrol Dial Transplant 2002; 17:1204.
- Satoskar AA, Nadasdy G, Plaza JA, et al. Staphylococcus infection-associated glomerulonephritis mimicking IgA nephropathy. Clin J Am Soc Nephrol 2006; 1:1179.
- Satoskar AA, Molenda M, Scipio P, et al. Henoch-Schönlein purpura-like presentation in IgA-dominant Staphylococcus infection - associated glomerulonephritis - a diagnostic pitfall. Clin Nephrol 2013; 79:302.
- Glassock RJ. Glomerular disease in the elderly. Clin Geriatr Med 2009; 25:413.
- Choi HK, Lamprecht P, Niles JL, et al. Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies. Arthritis Rheum 2000; 43:226.
- Chirinos JA, Corrales-Medina VF, Garcia S, et al. Endocarditis associated with antineutrophil cytoplasmic antibodies: a case report and review of the literature. Clin Rheumatol 2007; 26:590.
- Hanf W, Serre JE, Salmon JH, et al. [Rapidly progressive ANCA positive glomerulonephritis as the presenting feature of infectious endocarditis]. Rev Med Interne 2011; 32:e116.
- Boils CL, Nasr SH, Walker PD, et al. Update on endocarditis-associated glomerulonephritis. Kidney Int 2015; 87:1241.
- Brodsky SV, Satoskar A, Chen J, et al. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases. Am J Kidney Dis 2009; 54:1121.
- Brodsky SV, Collins M, Park E, et al. Warfarin therapy that results in an International Normalization Ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease. Nephron Clin Pract 2010; 115:c142.
- Brodsky SV, Nadasdy T, Rovin BH, et al. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int 2011; 80:181.
- Majumdar A, Chowdhary S, Ferreira MA, et al. Renal pathological findings in infective endocarditis. Nephrol Dial Transplant 2000; 15:1782.
- Vella J, Carmody M, Campbell E, et al. Glomerulonephritis after ventriculo-atrial shunt. QJM 1995; 88:911.
- Kiryluk K, Preddie D, D'Agati VD, Isom R. A young man with Propionibacterium acnes-induced shunt nephritis. Kidney Int 2008; 73:1434.
- Sorger K, Gessler M, Hübner FK, et al. Follow-up studies of three subtypes of acute postinfectious glomerulonephritis ascertained by renal biopsy. Clin Nephrol 1987; 27:111.
- Nasr SH, D'Agati VD. IgA-dominant postinfectious glomerulonephritis: a new twist on an old disease. Nephron Clin Pract 2011; 119:c18.
- Bu R, Li Q, Duan ZY, et al. Clinicopathologic features of IgA-dominant infection-associated glomerulonephritis: a pooled analysis of 78 cases. Am J Nephrol 2015; 41:98.
- Nasr SH, Markowitz GS, Whelan JD, et al. IgA-dominant acute poststaphylococcal glomerulonephritis complicating diabetic nephropathy. Hum Pathol 2003; 34:1235.
- Nagaba Y, Hiki Y, Aoyama T, et al. Effective antibiotic treatment of methicillin-resistant Staphylococcus aureus-associated glomerulonephritis. Nephron 2002; 92:297.
- Worawichawong S, Girard L, Trpkov K, et al. Immunoglobulin A-dominant postinfectious glomerulonephritis: frequent occurrence in nondiabetic patients with Staphylococcus aureus infection. Hum Pathol 2011; 42:279.
- Hirayama K, Kobayashi M, Kondoh M, et al. Henoch-Schönlein purpura nephritis associated with methicillin-resistant Staphylococcus aureus infection. Nephrol Dial Transplant 1998; 13:2703.
- Eftychiou C, Samarkos M, Golfinopoulou S, et al. Henoch-Schonlein purpura associated with methicillin-resistant Staphylococcus aureus infection. Am J Med 2006; 119:85.
- Gale DP, de Jorge EG, Cook HT, et al. Identification of a mutation in complement factor H-related protein 5 in patients of Cypriot origin with glomerulonephritis. Lancet 2010; 376:794.
- Rovin BH, Tang Y, Sun J, et al. Clinical significance of fever in the systemic lupus erythematosus patient receiving steroid therapy. Kidney Int 2005; 68:747.
- Agarwal A, Clements J, Sedmak DD, et al. Subacute bacterial endocarditis masquerading as type III essential mixed cryoglobulinemia. J Am Soc Nephrol 1997; 8:1971.
- Monga G, Mazzucco G, di Belgiojoso GB, et al. Pattern of double glomerulopathies: a clinicopathologic study of superimposed glomerulonephritis on diabetic glomerulosclerosis. Mod Pathol 1989; 2:407.
- Yum M, Maxwell DR, Hamburger R, Kleit SA. Primary glomerulonephritis complicating diabetic nephropathy: report of seven cases and review of the literature. Hum Pathol 1984; 15:921.
- CLINICAL MANIFESTATIONS
- Findings at presentation
- Most common sites of infection
- Laboratory tests
- - Bacterial cultures
- Diagnostic criteria
- Indications for kidney biopsy
- Histologic findings
- - Light microscopy
- - Immunofluorescence microscopy
- - Electron microscopy
- - IgA-dominant Staphylococcus-associated glomerulonephritis
- Distinction from IgA nephropathy
- DIFFERENTIAL DIAGNOSIS AND EVALUATION FOR OTHER CAUSES
- Distinction from C3 glomerulonephritis
- MONITORING AFTER DIAGNOSIS
- Eradicate the infection
- Control hypertension and edema
- Do not use immunosuppressive therapy
- Persistent or recurrent disease
- Renal prognosis
- SUMMARY AND RECOMMENDATIONS