Clinicopathologic features of infection-related glomerulonephritis with IgA deposits: a French Nationwide study

Miquelestorena-Standley, Élodie; Jaulerry, Charlotte; Machet, Marie‐Christine; Rabot, Nolwenn; Barbet, Christelle; Hummel, Aurélie; Karras, Alexandre; Garrouste, Cyril; Crépin, Thomas; Ducloux, Didier; Cousin, Maud; Albert, Catherine M.; Rivalan, Joseph; Gall, Emilie Cornec-Le; Pourreau, François; Deltombe, Clément; Nochy, Dominique; Szlavik, Nora; Félix, Sophie; Croué, Anne; Buob, David; Doucet, Laurent; Goujon, Jean-Michel; Renaudin, Karine; Blanchard, Emmanuelle; Eymieux, Sébastien; Rabant, Marion

doi:10.1186/s13000-020-00980-6

Cited by 12 publications

(9 citation statements)

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“…Of note, six patients with STEC-unrelated infections had a kidney biopsy (four had bacteria, and two had active viral infection [one CMV and one EBV]): four patients with a definite TMA (including one patient with cryoglobulinemia and one patient with class 4 lupus nephritis), one patient with suspicion of TMA with severe arteriolar hyalinosis, and one patient without TMA (who had proliferative GN with IgA and C3 deposits due to Schoenlein–Henoch disease or infection-related GN with IgA deposits [17]).…”

Section: Resultsmentioning

confidence: 99%

Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation

Thoreau

Tokarski

Bauvois

et al. 2021

CJASN

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Background and objectivesIn contrast to shigatoxin-associated Escherichia coli (STEC) causing hemolytic uremic syndrome, STEC-unrelated infections associated with thrombotic microangiopathy are less characterized.Design, setting, participants, & measurementsOur retrospective study in a four-hospital institution of 530 consecutive patients with adjudicated thrombotic microangiopathies during the 2009–2016 period studied STEC-unrelated infections’ epidemiology and major outcomes (death, acute dialysis, and major cardiovascular events).ResultsSTEC-unrelated infection was present in 145 of 530 (27%) patients, thrombotic microangiopathies without infection were present in 350 of 530 (66%) patients, and STEC causing hemolytic and uremic syndrome was present in 35 of 530 (7%) patients. They (versus thrombotic microangiopathy without infection) were associated with age >60 years (36% versus 18%), men (53% versus 27%), altered consciousness (32% versus 11%), mean BP <65 mm Hg (21% versus 4%), lower hemoglobin and platelet count, and AKI (72% versus 49%). They were associated with more than one pathogen in 36 of 145 (25%) patients (either isolated [14%] or combined [86%] to other causes of thrombotic microangiopathy); however, no significant clinical or biologic differences were noted between the two groups. They were more frequently due to bacteria (enterobacteria [41%], Staphylococcus aureus [11%], and Streptococcus pneumonia [3%]) than viruses (Epstein–Barr [20%], cytomegalovirus [18%], influenza [3%], hepatitis C [1%], HIV [1%], and rotavirus [1%]). STEC-unrelated infections were independent risk factors for in-hospital death (odds ratio, 2.22; 95% confidence interval, 1.18 to 4.29), major cardiovascular event (odds ratio, 3.43; 95% confidence interval, 1.82 to 6.69), and acute dialysis (odds ratio, 3.48; 95% confidence interval, 1.78 to 7.03). Bacteria (versus other pathogens), and among bacteria, enterobacteria, presence of more than one bacteria, and E. coli without shigatoxin were risk factors for acute dialysis.ConclusionsInfections are frequent thrombotic microangiopathy triggers or causes, and they are mostly unrelated to STEC. Infections convey a higher risk of death and major complications. The most frequent pathogens were enterobacteria, S. aureus, Epstein–Barr virus, and cytomegalovirus.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN17511120.mp3

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Section: Resultsmentioning

confidence: 99%

Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation

Thoreau

Tokarski

Bauvois

et al. 2021

CJASN

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“…To the best of our knowledge, no previous study has addressed this issue in spite of diabetes being the most common predisposing factor, especially in developed countries [10%-44% vs. 3%-21% (developing countries)]. 3,[9][10][11][12][13][14][15][16] IRGN remains as one of the most common causes of non-diabetic kidney disease in developing countries [8%-21% (developing countries) vs. 0%-4%…”

Section: Discussionmentioning

confidence: 99%

Bacterial infection‐related glomerulonephritis in patients with diabetes

et al. 2023

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AimDiabetic patients are prone to infections, thus making them a unique cohort at risk of developing bacterial infection‐related glomerulonephritis (IRGN).MethodsIn total, 1693 adult diabetic patients underwent kidney biopsy between 2005 and 2021 at our tertiary care hospital in South India. Of these, 121 consecutive cases which met criteria of bacterial IRGN were included in this study.ResultsThe mean age of the cohort was 53.1 ± 10.1 years and 83/121 (68.5%) were males. Majority (98.3%) had type 2 diabetes for a median duration of 6 (IQR, 2–12) years. The most common sites of infection were skin (47/121, 38.8%) and urinary tract (15/121, 12.4%). Fifty percent (58/121) of patients had underlying advanced diabetic kidney disease (DKD). Isolated C3 deposits (without immunoglobulin) occurred in 66/121 (54.5%) patients predominantly in advanced DKD patients. IgA‐dominant glomerulonephritis occurred in only 9/121 (7.4%) patients. Short‐course oral steroid was given to 86/121 (71.1%) patients. Steroid related dysglycemia and immunosuppression related infections occurred in 9/61 (14.8%) and 16/61 (26.2%) patients respectively. Of the 90 patients with follow up details >3 months, 46 (51.1%) progressed to kidney failure over a median period of 0.5 (IQR, 0–7.2) months. Patients diagnosed in the latter half of our study period (2013–2021) were older, less commonly presented with fever, had more pronounced hypocomplementemia and severe renal histology predominantly with a ‘starry sky’ immunofluorescence pattern.ConclusionSuperimposed bacterial IRGN on underlying DKD is associated with poor renal outcomes. Use of short course steroid was associated with significant toxicity.

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“…The proportion of patients with Hepatitis B is relatively high (14 %). The reason may be due to the high prevalence rate of Hepatitis B in China, or there may be some correlation between the two diseases which was mentioned by Miquelestorena-Standley, E. et al in their report and is worthy of further study [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The retrospective comparative study of TakayaHanda et al [ 3 ] showed that IgA-dominant postinfectious glomerulonephritis was characterized by the immunoglobulin and complement deposition along the glomerular capillary wall accounted for 15.4-54 %, which was different from primary IgA nephropathy. Miquelestorena-Standley, E. et al reported that IgA depositsion along capillary wall accounted for 19.2-46.2 % [ 12 ]. However, our study found that immunoglobulins and complements mainly deposited in the mesangial area (0.0-100 %), and capillary wall deposition only accounted for 2.0-22.0 %.…”

Section: Discussionmentioning

confidence: 99%

“…Reports of the IgA-dominant postinfectious glomerulonephritis have gradually increased in recent years, and many cases have an atypical presentation, making it difficult to differentiate the disease from primary IgA nephropathy, where the prognosis differs considerably. Most of these research were case reports, retrospective reviews or case series in a single center, and the sample size was often small, leading it hard to fully explain the clinicopathological characteristics and prognosis of the disease and the differentiation from similar diseases [ 5 – 12 ]. Therefore, in-depth research of the clinicopathological features and prognosis of IgA-dominant postinfectious glomerulonephritis has an important clinical significance.…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological and prognostic study of IgA-dominant postinfectious glomerulonephritis

et al. 2021

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Background The clinicopathological and prognostic features of IgA-dominant postinfectious glomerulonephritis and its difference from the primary IgA nephropathy remains to be investigated. Methods The clinical and pathological data of 6542 patients who underwent renal biopsy from 2009 to 2020 in our hospital were reviewed and 50 patients who met the selection criteria of IgA-dominant postinfectious glomerulonephritis were enrolled to conduct a retrospective and observational single-center study. The selection criteria were: meet the characteristics of IgA dominance or codominance in immunofluorescence, and conform to 3 of the following 5 criteria: 1.Clinical or laboratory evidence show that there is infection before or at the onset of glomerulonephritis; 2.The level of serum complement decreased; 3.Renal pathology is consistent with endocapillary proliferative glomerulonephritis; 4. Glomerular immunofluorescence staining showed complement C3 dominance or codominance; 5. Hump-like subepithelial immune complex deposition was observed under electron microscopy. According to age, sex, renal function (estimated glomerular filtration rate, eGFR) and follow-up time, the control group was constructed with 1:3 matched cases of primary IgA nephropathy. The clinicopathological and prognostic differences between the two groups were analyzed. Results The most common histological pattern of IgA-dominant postinfectious glomerulonephritis was acute endocapillary proliferative glomerulonephritis and exudative glomerulonephritis. Immunofluorescence showed mainly IgA deposition or IgA deposition only, mainly deposited in the mesangial area (deposition rate 100 %), with typical C3 high-intensity staining (intensity++~+++), mainly deposited in the mesangial area (deposition rate 92.0 %). The fluorescence intensity of kappa is usually not weaker than lambda. The probability of the appearance of typical hump-like electron deposition under electron microscopy is low. Compared to primary IgA nephropathy, patients with IgA-dominant postinfectious glomerulonephritis had higher proportion of crescents (p = 0. 005) and endocapillary hypercellularity (p < 0.001) in pathological manifestations. Using serum creatinine level doubled of the baseline or reached end-stage renal disease as the endpoint, the prognosis of IgA-dominant postinfectious glomerulonephritis patients was worse than that of primary IgA nephropathy patients (p = 0.013). Conclusions The clinicopathological features of patients with IgA-dominant postinfectious glomerulonephritis was different from that of primary IgA nephropathy, and the prognosis was worse.

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Clinicopathologic features of infection-related glomerulonephritis with IgA deposits: a French Nationwide study

Cited by 12 publications

References 34 publications

Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation

Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation

Bacterial infection‐related glomerulonephritis in patients with diabetes

Clinicopathological and prognostic study of IgA-dominant postinfectious glomerulonephritis

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