Abstract: TH-PO198

Gastric Stimulator Infection Complicated by Post-Infectious Glomerulonephritis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Woodell, Tyler, Oregon Health & Science University, Portland, Oregon, United States
  • Avasare, Rupali S., Oregon Health & Science University, Portland, Oregon, United States
Background

Acute poststreptococcal glomerulonephritis, though considered rare among adults in developed countries, remains a serious health concern. In contrast to the typical skin or throat infection preceding acute poststreptococcal glomerulonephritis, here we report to our knowledge the first case of infection-related glomerulonephritis associated with intraabdominal infection after gastric stimulator placement.

Methods

A 24 year-old woman with type 1 diabetes mellitus complicated by gastroparesis and proteinuric stage IIIa chronic kidney disease undergoes placement of a gastric stimulator after multiple emergency room visits for intractable vomiting. She develops severe abdominal pain on postoperative day 27 and presents to the emergency room. On physical exam she is febrile to 102.5 °F, tachycardic to 135 beats per minute and hypotensive to 80s/40s mmHg. Diagnostic studies are remarkable for a serum creatinine of 2 mg/dL (increased from 1.5 mg/dL one month prior), a white blood cell count of 29,000/mL (94% neutrophils) and a CT scan of the abdomen and pelvis that reveals a fluid collection adjacent to the gastric stimulator; blood cultures are negative. She is started on vancomycin and piperacillin-tazobactam and, on postoperative day 30, diagnostic laparoscopy reveals purulent fluid around the stimulator for which it is removed. Intraoperative cultures grow group A Streptococcus pyogenes. The patient’s antibiotics are narrowed and her clinical status improves. Despite rapid initial improvement in renal function, the patient develops recurrent kidney injury four days after removal of the gastric stimulator characterized by a rise in creatinine from 1.4 mg/dL to 2.9 mg/dL over the subsequent two weeks and oliguria; C3 is reduced and C4 is normal. She is started on hemodialysis for volume overload. A kidney biopsy is performed and findings are significant for mesangial proliferation, exudative endocapillary hypercellularity and interstitial eosinophilia. Electron microscopy reveals mesangial and subepithelial deposits. A diagnosis of infection-related glomerulonephritis is established and, after two months of supportive care, she is able to discontinue hemodialysis.

Results

Clinicians should maintain suspicion for post-infectious glomerulonephritis in the absence of classic infection and, when appropriate, perform a kidney biopsy for its confirmation.