Abstract: TH-PO0513
Active IgA-Dominant Infection-Related Glomerulonephritis Despite Sustained Bacterial Eradication Subsequently Mitigated with Corticosteroids
Session Information
- Glomerular Diseases: IgAN, IgA Vasculitis, and More
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Khalid, Saber, University of Benghazi, Benghazi, Libya
- Mubarak, Anees Mohammed, University of Benghazi, Benghazi, Libya
- Shueib, Ali, Ochsner Health, New Orleans, Louisiana, United States
- Alshaykhi, Mahmoud Yadim, University of Benghazi, Benghazi, Libya
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
- Mohamed, Muner, Ochsner Health, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology
Introduction
Management of infection-related glomerulonephritis (IRGN) is focused on treatment of the underlying infection. However, renal recovery may not always follow this conservative approach. Immunosuppressive therapy (IST) remains controversial and not supported by consistent evidence. In particular, it remains unclear whether IST is safe and effective to foster resolution of IRGN if the glomerular insult remains active despite eradication of the bacterial infection. We describe a case of a patient who despite complete resolution of an infection went on to develop severe acute kidney injury (AKI) due to IRGN and was successfully rescued with corticosteroids.
Case Description
An 80-year-old man with type 2 diabetes mellitus developed acute cholecystitis complicated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and received treatment with intravenous vancomycin. Three weeks later, blood and abdominal cultures turned consistently negative. At that time, he was noted to have an elevated serum creatinine (sCr) at 2.1 mg/dL (from a baseline of 1.3 mg/dL). Over the ensuing 6 weeks, he underwent inpatient physical rehabilitation while the cultures remained negative. However, his kidney function progressively declined despite fluid resuscitation and discontinuation of nephrotoxins. He became oliguric, his sCr peaked at 7.1 mg/dL, and necessitated renal replacement therapy (RRT). Labs revealed low serum C3, a urine protein-to-creatinine ratio 17 g/g, and acanthocytes and waxy casts on urinary sediment microscopy. A kidney biopsy demonstrated diffuse proliferative glomerulonephritis with IgA-dominant immune complex deposition, consistent with IRGN. Because of the AKI-RRT and active glomerulonephritis despite bacterial eradication, corticosteroids were initiated. Gradual improvement in kidney function followed and RRT was stopped.
Discussion
IgA-dominant IRGN is described in association with Staphylococcus aureus infections. In most cases, bacteremia and active IRGN overlap. However, this case illustrates that IgA-dominant IRGN can peak during the postinfectious period. Furthermore, IST may be considered once the infection has cleared up if the severity of the renal syndrome warrants it. Controlled studies are needed to examine these scenarios.