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Diagnosis: Acute postinfectious glomerulonephritis (in resolution).

Acute glomerulonephritis (GN) that follows infections is a common glomerular disease, but diagnosis confirmation requires to demonstrate the previous infection. In diffuse endocapillary GN cases without infection evidence, the infection could be happened long time back as to detect evidence of the immune response to the microorganism.

The present case is very interesting due to clinical presentation with rapidly progressive GN and association with skin and cerebral lesions. Several reports have demonstrate systemic vasculitis associated to postinfectious GN (including skin and central nervous system involvement). The etiology and pathogenesis are not completely understood. Prognosis is usually good, with complete resolution of the systemic vasculitis with GN resolution. Treatment is similar to postinfectious GN without vasculitis. Steroids an other immunosuppressors have been used in different reports.

Pontine myelinolysis can develop in patients with rapid correction of hyponatremia, but in the patient there was not severe sodium levels alterations, then, other examiners think that the cerebral lesions are due to vasculuitis. In conclusion, it is not clear if cerebral lesions are secondary to vasculitis or rapid correction of the sodium levels.

Three months after biopsy renal function is normal without alterations in the urinalysis. There are not lesions in the skin, and neurologic alteration persists with only mild improvement.

See the chapter Proliferative endocapillary glomerulonephritis (English version).

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Bibliography

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