Comment on ; Post-infectious glomerulonephritis presenting as acute renal failure in a patient with Lyme disease

نویسنده

  • Hamid Nasri
چکیده

*Corresponding author: Prof. Hamid Nasri, Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: [email protected] The interesting article, published by Rolla et al, had some points needs more description. They reported a post-infectious glomerulonephritis secondary to Borrelia burgdorferi infection in a 61-year old man (1). The diagnosis of glomerulonephritis was IgA nephropathy, through immunofluorescence study by significant IgA deposits in the mesangial area and negative C1q deposits. They concluded that, Borrelia burgdorferi is a possible cause of post-infectious glomerulonephritis in humans as it is in dogs. While most cases of IgA nephropathy (IgAN) are idiopathic, various diseases are associated with IgAN (1). Between July 2000 and February 2009, 21 cases of post infectious glomerulonephritis were evaluated by Wen et al. in Taiwan. They found, glomerular IgA dominant or co-dominant deposition was more frequently seen in atypical pattern (2). Various findings have suggested that IgAN may be a consequence of infections, possibly due to an abnormal IgA-mediated immune response against microbial antigens with formation of nephrotoxic immune complexes (3). It is possible that removal of the causative organism from circulation by appropriate treatment leads to improvements in kidney function through increased clearance of immunecomplexes, thus leading to the resolution of IgA nephropathy (4-7). Recently we had reported a 28-year-old man was admitted because of fever and abdominal pain. Primary evaluations showed right kidney pyonenphrosis. In spite of placing a nephrostomy tube, fever continued. Repeated CT revealed focal pyelonephritis. Additionally, peripheral blood smear suggested malaria. Anti-malarial agents were initiated and right nephrectomy was conducted. One year after recovery from malaria, a persistent rise in serum creatinine was detected (creatinine before disease was 0.8 mg/dl which reached to 1.6 mg/dl). A left renal biopsy showed mild mesangial proliferation with dominant IgA deposits (>2+) in immunofluorescence study while C1q was not deposited (8). The impression was immunoglobulin A nephropathy with M1E0S0T0 (Oxford classification). The patient was prescribed a combination of low dose prednisolone and angiotensin converting enzyme inhibitor. Six months after treatment serum creatinine decreased from 1.6 mg/dl to 1.3 mg/dl and urine sediment became normal. Our findings suggest that malaria infection might be associated with IgA nephropathy. IgAN is the most common primary glomerulonephritis through the world. It is defined by mesangial cell proliferation, expansion of the extracellular matrix, and predominant IgA deposition in the mesangium region (8). In summary, the clinical pattern and the final outcome of involved patients may vary depending on the severity of renal lesions detected at kidney biopsy. Indeed, one of the potent point of this case, was classification of IgAN by Oxford system, which best shows the severity of six morphologic lesions of this classification and will give an exact interpretation for treatmental medalities (4-7).

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Post-infectious glomerulonephritis presenting as acute renal failure in a patient with Lyme disease

INTRODUCTION We report a case of a patient with acute renal failure in Lyme disease-associated focal proliferative mesangial nephropathy. Lyme disease is a vector-borne disease caused by Borrelia burgdorferi, transmitted by the bite of an infected ixodes tick. Post-infectious glomerulonephritis (GN)secondary to Borrelia burgdorferi infection in man could be fatal, as it is in canine Lyme borrel...

متن کامل

Accuracy of modification of diet for renal disease and Cockcroft-Gault equations as compared to the radioisotope double sample method: A study in patients with acute renal failure

Introduction: We intended to assess the accuracy of re-expressed Modification of Diet for Renal Disease (MDRD) and Cockcroft-Gault (CG) equations to estimate glomerular filtration rate (GFR) in chronic kidney disease in two different etiologies of acute renal failure (ARF): acute tubular necrosis (ATN) and acute glomerulonephritis (AGN). Methods: Patients admitted for ARF or the patients compl...

متن کامل

Infective endocarditis mimics ANCA associated glomerulonephritis

Background: Sub-acute bacterial endocarditis (SBE) rarely presents with features of a small vessel vasculitis. Patients with SBE can also develop multiple serological abnormalities including ANCA. In this report, we present a case of infective endocarditis mimicked ANCA associated glomerulonephritis.Case presentation: A 57-year old male with a clinical picture of rapidly progressive renal failu...

متن کامل

A case report of typhoid fever masquerading as acute typhoid glomerulonephritis

IJCRI – International Journal of Case Reports and Images, Vol. 2, No. 3, March 2011. ISSN – [0976-3198] ABSTRACT Introduction: Typhoid fever is a common infectious disease worldwide, especially in developing countries. Typhoid fever presenting as nephritis is rare. The common renal complications of typhoid fever are pyelonephritis and cystitis. Patients with typhoid glomerulonephritis may prese...

متن کامل

Glutaric Aciduri Type II, with Rhabdomyolysis and Acute Renal Failure Presentation in 10 Years Old Girl

Introduction: Myopathy and rhabdomyolysis are not common in children and, if not detected and do not treated it will be associated with high mortality and morbidity rate. The causes of rhabdomyolysis include hypokalemia, trauma, viral myositis, poisoning, rheumatoid diseases, and metabolic myopathies. Rhabdomyolysis treatment includes rapid supportive care and treatment of the underlying dise...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 3  شماره 

صفحات  -

تاریخ انتشار 2014