Acute poststreptococcal glomerulonephritis mimicking Henoch- Schönlein purpura

Matsukura, Hiro; Ohtsuki, A; Fuchizawa, Tatsuya; Miyawaki, T

doi:10.5414/cnp59064

Cited by 18 publications

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“…Both AGN and HSP nephritis could appear after antigen exposure with similar clinical presentation such hematuria, edemas and hypertension [2,5,6]. In this case, streptococcus infection was supported by clinical data and high serum ASLO levels that decreased subsequently.…”

Section: Discussionmentioning

confidence: 72%

“…Although in this GN the complement system is usually activated by alternative pathway, it has been described as the activation by classical pathway, characterized by low levels of C4 without decrease of C3, as we observed in our patient. Moreover, GNA has also been described as having the presence of systemic vasculitis affecting skin, bowel and other organs mimicking HSP [5,6]. On the other hand, the presence of purpura and absence of typical nephritic syndrome supported the diagnosis of HSP.…”

Section: Discussionmentioning

confidence: 99%

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Henoch-Schönlein nephritis associated with streptococcal infection and persistent hypocomplementemia: a case report

et al. 2010

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IntroductionHenoch-Schönlein purpura is a systemic disease with frequent renal involvement, characterized by IgA mesangial deposits. Streptococcal infection can induce an abnormal IgA immune response like Henoch-Schönlein purpura, quite similar to typical acute post-infectious glomerulonephritis. Indeed, hypocomplementemia that is typical of acute glomerulonephritis has also been described in Henoch-Schönlein purpura.Case presentationWe describe a 14-year-old Caucasian Spanish girl who developed urinary abnormalities and cutaneous purpura after streptococcal infection. Renal biopsy showed typical findings from Henoch-Schönlein purpura nephritis. In addition, she had low serum levels of complement (C4 fraction) that persisted during follow-up, in spite of her clinical evolution. She responded to treatment with enalapril and steroids.ConclusionThe case described has, at least, three points of interest in Henoch-Schönlein purpura: 1) Initial presentation was preceded by streptococcal infection; 2) There was a persistence of low serum levels of complement; and 3) There was response to steroids and angiotensin-converting enzyme inhibitor in the presence of nephrotic syndrome. There are not many cases described in the literature with these characteristics. We conclude that Henoch-Schönlein purpura could appear after streptococcal infection in patients with abnormal complement levels, and that steroids and angiotensin-converting enzyme inhibitor could be successful treatment for the disease.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Henoch-Schönlein nephritis associated with streptococcal infection and persistent hypocomplementemia: a case report

et al. 2010

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“…However, acute poststreptococcal glomerulonephritis (APGN) has been considered to be the most common form of immune-mediated glomerulopathy related to GAS infection [16]. Interestingly, there have been several reports suggesting that patients with APGN occasionally exhibit a purpuric rash similar to the skin manifestations of HSP [17,18]. In addition, it has been reported that hypocomplementemia may be associated with HSPN, and also that renal lesions of HSPN include varying degrees of endocapillary proliferative changes, which are typical findings of APGN [1,8,12,19].…”

Section: Discussionmentioning

confidence: 98%

Clinical remission of Henoch–Schönlein purpura nephritis after a monotherapeutic tonsillectomy

et al. 2010

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We herein describe an adult male patient who presented with tonsillitis, purpura, hematuria, and proteinuria. The serological analyses revealed elevated serum antistreptolysin, and the throat culture yielded Lancefield group A β-hemolytic streptococci. A renal biopsy revealed mild mesangial proliferation associated with granular mesangial depositions of IgA and C3, consistent with Henoch-Schönlein purpura nephritis (HSPN). Initially, the patient was treated with dipyridamole, which was followed by limited improvements in the proteinuria and hematuria. Nine months later, the tonsillitis relapsed due to GAS infection and deteriorated urinary abnormalities were noticed, which finally disappeared after monotherapeutic tonsillectomy. Although the impact of tonsillectomy on the treatment of HSPN remains to be characterized, our observations suggest that tonsillectomy in the present patient played a pivotal role in facilitating the recovery of the renal injuries. Because the arbitrary application of a tonsillectomy appears to be accompanied by ethical concerns, the evaluation of the clinical benefits of this procedure should be addressed more directly in the future.

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“…Another atypical feature at presentation is the presence of a typical Henoch-Schönlein purpura rash [142][143][144]. The diagnosis of PSAGN was confirmed by renal biopsy in those cases.…”

Section: Clinical Manifestations-typical Course Atypical Featuresmentioning

confidence: 94%

Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis

et al. 2010

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Post-streptococcal acute glomerulonephritis (PSAGN) is one of the most important and intriguing conditions in the discipline of pediatric nephrology. Although the eventual outcome is excellent in most cases, PSAGN remains an important cause of acute renal failure and hospitalization for children in both developed and underdeveloped areas. The purpose of this review is to describe both the typical and less common clinical features of PSAGN, to outline the changes in the epidemiology of PSAGN over the past 50 years, and to explore studies on the pathogenesis of the condition with an emphasis on the search for the elusive nephritogenic antigen.

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Acute poststreptococcal glomerulonephritis mimicking Henoch- Schönlein purpura

Cited by 18 publications

References 0 publications

Henoch-Schönlein nephritis associated with streptococcal infection and persistent hypocomplementemia: a case report

Henoch-Schönlein nephritis associated with streptococcal infection and persistent hypocomplementemia: a case report

Clinical remission of Henoch–Schönlein purpura nephritis after a monotherapeutic tonsillectomy

Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis

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