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Kidney Week

Abstract: PO0289

Staphylococcus aureus-Associated Infection-Related Glomerulonephritis (IRGN) in an Elderly Male

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Khan, Iman Sajid, Weill Cornell Medicine, New York, New York, United States
  • Tao, Alice J., Weill Cornell Medicine, New York, New York, United States
  • Grenet, Justin Edward, Weill Cornell Medicine, New York, New York, United States
  • Smith, Emiliy S., Weill Cornell Medicine, New York, New York, United States
  • Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
  • Silberzweig, Jeffrey I., Rogosin Institute, New York, New York, United States
Introduction

IRGN commonly occurs in children following Streptococcal upper respiratory tract or skin infections. However, more cases are now being described in adults with symptoms ranging from microscopic hematuria to dialysis dependence. Herein, we describe a case of IRGN in an elderly male in association with a heel ulcer.

Case Description

An 88-year-old man with hypertension, chronic kidney disease stage 3 (baseline creatinine (Cr) 1.6-1.8 mg/dL), rheumatoid arthritis & peripheral artery disease presented with a Cr of 8 mg/dL. 3 weeks prior to presentation, he was hospitalized for a right heel abscess, treated with doxycycline for 5 days & discharged with a Cr of 1.84 mg/dL. Wound cultures grew methicillin sensitive Staphylococcus aureus, E. coli & coryneform bacteria. 7 days after discontinuing doxycycline, he developed oliguria & a pruritic rash on his chest & arms & was readmitted.
Urinalysis revealed >50 RBCs, >50 WBCs, 100 protein & few bacteria without casts. Urine protein to Cr ratio was 3.3 g/dL, fractional excretion of sodium was 4.4% & eosinophil count 6.8%. Additional labs included C3 64 mg/dL, C4 32.8 mg/dL & ANA 1:320, with speckled pattern. ESR was 46 mm/hr & CRP was 3.3 mg/dL, with negative blood & urine cultures. Renal ultrasound showed bilateral echogenic kidneys without hydronephrosis.
Recent antibiotic use, rash, peripheral eosinophilia & acute kidney injury suggested acute interstitial nephritis. He was started on prednisone 1mg/kg/day. Hemodialysis (HD) was initiated for volume overload & uremic encephalopathy. His kidney function did not improve with prednisone & a renal biopsy was performed. Pathology revealed diffuse exudative glomerulonephritis, prominent C3-only staining, active interstitial inflammation, & subepithelial deposits consistent with IRGN. Despite improved respiratory status with HD, his mental status deteriorated, kidney function did not recover & he died on the 20th day of admission.

Discussion

While prognosis for IRGN is excellent in children with nearly 95% recovery; about half of affected adults become dialysis dependent. Our case is unique as it (a) highlights the need for a high index of suspicion for IRGN in an adult patient recovering from infection & (b) implores nephrologists to have a low threshold to perform a renal biopsy when noticing lack of improvement of AKI.