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Diagnosis: IgA-Dominant Infection-Related Glomerulonephritis
Immunoglobulin A (IgA)-dominant infection-related glomerulonephritis is a morphologic variant of acute infection-related glomerulonephritis that typically occurs in association with staphylococcal infection. It is most common in older patients and those with diabetes, and rare in children. Patients typically present with acute kidney injury, proteinuria, and hematuria. Hypocomplementemia is present in the vast majority of the patients. The prognosis is poor, with less than 20% of patients fully recovering kidney function, most likely owing to age-related underlying kidney changes and comorbidities, including diabetic kidney disease. The most common site of infection is skin, including cellulitis, surgical wound infection, skin abscesses, and intravenous line infection. The most common infectious agents are Staphylococcus, including methicillin-resistant Staphylococcus aureus (MRSA). Light microscopy: Glomeruli show segmental to global endocapillary hypercellularity with frequent neutrophils. Crescents may be present. Underlying changes of diabetic kidney disease may be present, including nodular glomerulosclerosis and arteriolar hyalinosis. Immunofluorescence microscopy: Glomeruli show chunky, irregular mesangial and capillary wall polyclonal IgA with lesser staining for IgG and prominent C3. The deposits often show a garland or starry-sky appearance as in typical poststreptococcal-related glomerulonephritis. Unlike IgA nephropathy, λ light chain is not typically dominant (the above text taken from: Paueksakon P, et al. AJKD Atlas of Renal Pathology: IgA-Dominant Infection-Related Glomerulonephritis. Am J Kidney Dis. 2024;83(1):e1-e2. [PubMed link]).
See the chapter: Proliferative endocapillary glomerulonephritis of our Tutorial.
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References
- Takagi Y, Kano Y, Oda T, Suzuki H, Ono Y, Yoshihara S. Pediatric IgA-Dominant Infection-Related Glomerulonephritis. Tohoku J Exp Med. 2024 Feb 15. Epub ahead of print. [PubMed link]
- Paueksakon P, Najafian B, Alpers CE, Fogo AB. AJKD Atlas of Renal Pathology: IgA-Dominant Infection-Related Glomerulonephritis. Am J Kidney Dis. 2024;83(1):e1-e2. [PubMed link]
- John EE, Roy S, Eapen JJ, Karuppusami R, Jose N, Mani SSR, Johny J, Alam R, Yusuf S, Thomas A, Valson AT, David VG, Varughese S, Alexander S. Bacterial infection-related glomerulonephritis in patients with diabetes. Nephrology (Carlton). 2023;28(11):597-610. [PubMed link]
- Sanathkumar HT, Fernando EM, Kurien AA, Srinivasaprasad ND, Suren S, Thirumalvalavan K. Clinical Profile, Histopathology, and Outcomes in Infection-Related Glomerulonephritis - Single-Center Experience. Indian J Nephrol. 2022;32(6):546-554. [PubMed link]
- Takayasu M, Hirayama K, Shimohata H, Kobayashi M, Koyama A. Staphylococcus aureus Infection-Related Glomerulonephritis with Dominant IgA Deposition. Int J Mol Sci. 2022;23(13):7482. [PubMed link]
- Okumura M, Sugihara S, Seki K, Nagaoka K, Okawa N, Ebihara M, Inoue T, Fukuda J, Ohara M, Imasawa T, Kitamura H, Oda T, Suzuki T. Use of Immunosuppressive Therapy in the Treatment of IgA-dominant Infection-related Glomerulonephritis. Intern Med. 2022;61(5):697-701. [PubMed link]
- Shimamura Y, Maeda T, Gocho Y, Ogawa Y, Takizawa H. IgA-dominant infection-related glomerulonephritis. Nefrologia (Engl Ed). 2018;38(6):669-670. [PubMed link]