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Diagnosis: Diffuse proliferative Glomerulonephritis
(With immunostaining showing "full house" pattern)

Diffuse proliferative glomerulonephritis is a term used to describe a distinct histologic form of glomerulonephritis common to various types of diseases, including infectious processes, autoimmune disorders (eg, systemic lupus erythematosus), and vasculitis (eg, Wegener granulomatosis). Glomeruli demonstrate increased mesangial, epithelial, endothelial, and inflammatory cells. The diagnosis is often suspected in a patient presenting with systemic inflammatory disease who manifests hematuria, proteinuria, active urinary sediment and/or rise in serum blood urea nitrogen and creatinine.

In the present case the prevoius infectious episode (pyodermitis) suggests postinfectious GN, however C1q deposition and "full house" pattern on immunofluorescence are not very usual in this cases. Due to it immunologic tests were done posterior to renal biopsy and ANAs were positive: 1:80 speckled pattern, anti-DNA native: 1:20; anti-Ro: 3.3 u/mL (0.0 - 15.0); and Anti-LA: 4.8 u/mL (0.0 - 15.0). Althoug the patient has not the criteria required to confirm a systemic lupus erythematosus diagnosis, this results indicate a high probability of the disease. Hypocomplementemia can be seen in both diseases: SLE and postinfectious GN, then this feature is not very useful in the differential diagnosis.

The patient was treated with metylprednisolone and cyclophosphamide; his serum creatinine was 1.3 mg/dL and cretinine clearance was 138.4 ml/min one month after treatment was begining.

Two issues are very important in the present case: 1.) all biopsies with diffuse proliferative endocapillary GN in patients with previous infectious processes are not necessarily postinfectious GN; and 2.) In patients with C1q deposition in glomeruli, or "full house" pattern of immunostaining, lupus nephritis must be thought. C1q positivity is rarely found in postinfectious GN.

See the chapter Proliferative endocapillary glomerulonephritis (English version).

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Bibliography

• Rodriguez-Iturbe B, Batsford S. Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet. Kidney Int. 2007;71:1094-104. [PubMed link]
• Salifu MO, Delano BG. Glomerulonephritis, diffuse proliferative. in eMedicine, consulted June 29 2007: Link: www.emedicine.com/med/topic882.htm
• Sotsiou F, Dimitriadis G, Liapis H. Diagnostic dilemmas in atypical postinfectious glomerulonephritis. Semin Diagn Pathol. 2002 Aug;19(3):146-59. [PubMed link]

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