Membranoproliferative glomerulonephritis and Pott's disease

Abstract

The reports of glomerular lesions of kidney due to tuberculosis are sparse. A 48-year-old gentleman, presented with swelling of feet of 3 months duration. As he had renal impairment, proteinuria and normal-sized kidneys, he was subjected to renal biopsy. The light microscopy and immunofluorescence revealed the diagnosis was membrano-proliferative glomerulonephritis. During hospital stay, the patient complained fever and stiffness at thoracic spine. The MRI of thoraco-lumbo-sacral spine revealed paravertebral abscess at D11-D12. The pus aspirated was positive for Mycobacterium tuberculosis. He was started on anti-tuberculous medication. After 8 weeks of therapy, the serum creatinine was 1.5 mg/dL and 24 h urine protein 250 mg.Keywords: acid-fast bacilli; membranoproliferative glomerulonephritis; nephrotic syndrome; Pott's disease; Ziehl-Neelsen stain Tuberculous involvement in the genitourinary tract is well reported in literature. However, reports of glomerular lesions due to tuberculosis are sparse. We report a patient with an association of tuberculosis and membranoproliferative glomerulonephritis.A 48-year-old man presented to our institute with complaints of swelling of the feet of 3 months duration. He also had a history of facial puffiness and oliguria. There was no history of haematuria or pyuria. He had no history of passing stones in the urine. There was history of prolonged frothiness of urine. On examination, blood pressure was 140/90 mmHg, he had paedal oedema, and facial puffiness. He had no history of hypertension or diabetes mellitus. Cardiovascular, respiratory and abdomen examinations were unremarkable. Results of other investigations were blood urea, 17.5 mmol/L (50 mg/dL); serum creatinine, 166.2 µmol/L (1.88 mg/dL); serum sodium, 134 mmol/L (134 mEq/L); serum potassium, 3.9 mmol/L (3.9 mEq/L); total serum protein, 60 g/L (6 g/dL); serum albumin, 30 g/L (3 g/dL); haemoglobin, 115 g/dL (11.5 g/ dL); 24-h urine protein, 1400 mg; urine albuminm 3+; red blood cells, 10-12/hpf; white blood cells, 10-12/hpf; ultrasound abdomen, right kidney: 11.3 × 5.1 cm and left kidney 10.2 × 4.8 cm, anti dsDNA, C-ANCA and P-ANCA: negative, C 3: 620 (reference range: 970-1576 mg/L), C 4: 79 (reference range: 102-445 mg/L).As he had renal impairment, proteinuria and normalsized kidneys, he was subjected to renal biopsy. Three linear grey-white soft tissue bits were reported with 10 glomeruli, all of them showing an increase in mesangial cell proliferation and mesangial matrix. There was lobular accentuation in all of them (Figure 1 and Supplementary Figure 1), a few of them showing neutrophil and lymphocyte infiltration. Tubules showed red blood cell casts. There was focal moderate interstitial lymphomononuclear infiltrate. Blood vessels were unremarkable. Immunofluorescence (IF) showed granular deposition of C3 in the capillary walls, outlining the lobular structure of the glomerulus. In addition IgG was also found, but was of less intensity. IgM, IgA, C1q and light chains were absent. The diagnosis was ...

Immunotactoid Glomerulopathy with Nontuberculous Mycobacterial Infection: A Novel Association

“…As direct evidence of the causal role of infectious agents has not been reported previously, a genomic fragment of M. intracellulare was not detected in our patient’s renal biopsy specimen [15‒17, 26, 27] . Considering the pathophysiology of immune complex-associated MPGN or paraprotein deposition diseases, including amyloidosis, cryoglobulinemia, and ITG massive chronic Ig production, are common.…”

“…Deposition of monoclonal Igs in the glomerular capillary walls and mesangial areas is another cause of immune complex-associated MPGN. Monoclonal [14] immune complex-associated MPGN can arise after mycobacterial infection [15, 16]. While most of such cases are tuberculosis, only 1 case with NTM has been reported in Japan.…”

“…complex-associated MPGN can arise after mycobacterial infection [15,16]. While most of such cases are tuberculosis, only 1 case with NTM has been reported in Japan.…”

Simultaneous presentation of membranoproliferative glomerulonephritis and tuberculous spondylitis: a case report

“…3 Reports of glomerular lesions of the kidney associated with TB are rare. 7 Renal TB can occur via direct invasion by bacilli, chronic interstitial nephritis, and renal amyloidosis. Histopathological changes may be consistent with IgA nephropathy, collapsing glomerulopathy, mesangioproliferative (MPGN), mesangiocapillary, and membranous glomerulonephritis.…”

“…The formation of antigen-antibody complexes and stimulation of the classical complement pathway is a possible mechanism that leads to MPGN. 7 MPGN may result from multiple other causes and may also be idiopathic. 8 Determining the exact cause of MPGN was challenging in our patient, since it was not practically possible to rule out all possible causes.…”