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Diagnosis: Diffuse proliferative endocapillary glomerulonephritis, postinfectious

Several aspects are very interesting in this case:

1. The appearance of mesangial widening.

2. Presence of only C3, without immunoglobulins.

3. The location predominantly mesangial of the deposits, despite having proliferative exudative lesions (with polymorphs).

4. Clinical presentation with massive proteinuria: 12.3 g/24h.

These four "atypical" features in a postinfectious GN have been well described in the literature. Diabetes may contribute to some extent with mesangial widening and proteinuria.

In GN associated with infections other than Steptococus there are often histologic or immunopathologic features considered "atypical". In this patient was documented that leg injury was due to Staphylococcus aureus infection

C3 glomerulonephritis was also considered into differential diagnosis, but clinical evolution was consistent with postinfectious GN.

Two monts after biopsy serum creatinine and complement were normal and proteinuria persisted: <1 g/24h.

See the Chapter Proliferative Endocapillary Glomerulonephritis of our Tutorial.

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References

• Kambham N. Postinfectious glomerulonephritis. Adv Anat Pathol. 2012;19(5):338-47. [PubMed link]
• Nast CC. Infection-related glomerulonephritis: changing demographics and outcomes. Adv Chronic Kidney Dis. 2012;19(2):68-75. [PubMed link]
• Luo C, Tang Z, Chen D, Liu Z. Long-term prognosis for Chinese adult patients with acute postinfectious glomerulonephritis. Clin Nephrol. 2011;76(3):186-94. [PubMed link]
• Nadasdy T, Hebert LA. Infection-related glomerulonephritis: understanding mechanisms. Semin Nephrol. 2011;31(4):369-75. [PubMed link]
• Wen YK, Chen ML. The significance of atypical morphology in the changes of spectrum of postinfectious glomerulonephritis. Clin Nephrol. 2010;73(3):173-9. [PubMed link]
• Wen YK. The spectrum of adult postinfectious glomerulonephritis in the new millennium. Ren Fail. 2009;31(8):676-82. [PubMed link]

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