Skip to main content

Advertisement

Log in

The features in IgA-dominant infection-related glomerulonephritis distinct from IgA nephropathy: a single-center study

  • Original article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

IgA-dominant infection-related glomerulonephritis (IgA-IRGN) is a unique form of IRGN, which needs to be distinguished from IgA nephropathy (IgAN).

Methods

Thirteen patients with IgA-IRGN (IgA-IRGN group) and 122 with IgAN (IgAN group) were selected from 1788 patients who underwent kidney biopsy between 2000 and 2015 in Kitano Hospital. Data selected included clinical and serological parameters; light and electron microscope findings; immunofluorescence findings; and prognostic parameters like renal and overall survival and creatinine increase by > 50%. In addition, a 26-patient IgAN cohort (matching-IgAN), matching with IgA-IRGN group with respect to age, sex, estimated glomerular filtration rate (eGFR), and proteinuria was segregated for comparison.

Results

Compared to IgAN group, IgA-IRGN group were older, had lower hemoglobin, higher CRP, lower eGFR, heavier proteinuria, lower serum albumin, and higher serum IgG and IgA levels (p < 0.05). Endocapillary hypercellularity, deposition of immune complexes along the glomerular capillary wall, and subendothelial and subepithelial electron dense deposits were more frequently observed (p < 0.05); and they were more susceptible to renal dysfunction and poorer prognosis. After propensity score-matching, serum albumin was significantly lower in the IgA-IRGN group. Significantly subendothelial and subepithelial deposits were frequently observed in this group. Matching-IgAN group showed relatively advanced sclerotic lesions with more global sclerosis and fibrous crescent.

Conclusion

Local inflammation involved glomerular capillary wall in IgA-IRGN, in contrast to relatively chronic and sclerotic renal lesion in IgAN, might result in poorer prognosis in former, even under indistinguishable condition of deteriorated renal function and proteinuria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nadasdy T, Hebert LA. Infection-related glomerulonephritis: understanding mechanisms. Semin Nephrol. 2011;31(4):369–75.

    Article  CAS  Google Scholar 

  2. Nasr SH, Radhakrishnan J, D’Agati VD. Bacterial infection-related glomerulonephritis in adults. Kidney Int. 2013;83(5):792–803.

    Article  CAS  Google Scholar 

  3. Nasr SH, Fidler ME, Valeri AM, Cornell LD, Sethi S, Zoller A, et al. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol. 2011;22(1):187–95.

    Article  Google Scholar 

  4. Nasr SH, Markowitz GS, Whelan JD, Albanese JJ, Rosen RM, Fein DA, et al. IgA-dominant acute poststaphylococcal glomerulonephritis complicating diabetic nephropathy. Hum Pathol. 2003;34(12):1235–41.

    Article  CAS  Google Scholar 

  5. Bu R, Li Q, Duan ZY, Wu J, Chen P, Chen XM, et al. Clinicopathologic features of IgA-dominant infection-associated glomerulonephritis: a pooled analysis of 78 cases. Am J Nephrol. 2015;41(2):98–106.

    Article  CAS  Google Scholar 

  6. Haas M, Racusen LC, Bagnasco SM. IgA-dominant postinfectious glomerulonephritis: a report of 13 cases with common ultrastructural features. Hum Pathol. 2008;39(9):1309–16.

    Article  CAS  Google Scholar 

  7. Nasr SH, D’Agati VD. IgA-dominant postinfectious glomerulonephritis: a new twist on an old disease. Nephron Clin Pract. 2011;119(1):c18–25 (discussion c6).

    Article  CAS  Google Scholar 

  8. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.

    Article  CAS  Google Scholar 

  9. Kikuchi H, Aoyagi M, Nagahama K, Yamamura C, Arai Y, Hirasawa S, et al. IgA-dominant postinfectious glomerulonephritis associated with Escherichia coli infection caused by cholangitis. Intern Med. 2014;53(22):2619–24.

    Article  Google Scholar 

  10. Barratt J, Feehally J. Primary IgA nephropathy: new insights into pathogenesis. Semin Nephrol. 2011;31(4):349–60.

    Article  CAS  Google Scholar 

  11. Pola E, Logroscino G, De Santis V, Canducci F, Delcogliano A, Gasbarrini A. Onset of Berger disease after Staphylococcus aureus infection: septic arthritis after anterior cruciate ligament reconstruction. Arthroscopy 2003;19(4):E29.

    Article  Google Scholar 

  12. Spector DA, Millan J, Zauber N, Burton J. Glomerulonephritis and Staphylococcal aureus infections. Clin Nephrol. 1980;14(5):256–61.

    CAS  Google Scholar 

  13. D’Amico G. Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome. Semin Nephrol. 2004;24(3):179–96.

    Article  Google Scholar 

  14. Ikee R, Kobayashi S, Saigusa T, Namikoshi T, Yamada M, Hemmi N, et al. Impact of hypertension and hypertension-related vascular lesions in IgA nephropathy. Hypertens Res. 2006;29(1):15–22.

    Article  Google Scholar 

  15. Koyama A, Kobayashi M, Yamaguchi N, Yamagata K, Takano K, Nakajima M, et al. Glomerulonephritis associated with MRSA infection: a possible role of bacterial superantigen. Kidney Int. 1995;47(1):207–16.

    Article  CAS  Google Scholar 

  16. Yoh K, Kobayashi M, Hirayama A, Hirayama K, Yamaguchi N, Nagase S, et al. A case of superantigen-related glomerulonephritis after methicillin-resistant Staphylococcus aureus (MRSA) infection. Clin Nephrol. 1997;48(5):311–6.

    CAS  Google Scholar 

  17. Yoh K, Kobayashi M, Yamaguchi N, Hirayama K, Ishizu T, Kikuchi S, et al. Cytokines and T-cell responses in superantigen-related glomerulonephritis following methicillin-resistant Staphylococcus aureus infection. Nephrol Dial Transplant. 2000;15(8):1170–4.

    Article  CAS  Google Scholar 

  18. Montseny JJ, Meyrier A, Kleinknecht D, Callard P. The current spectrum of infectious glomerulonephritis. Experience with 76 patients and review of the literature. Medicine (Baltimore). 1995;74(2):63–73.

    Article  CAS  Google Scholar 

  19. Moroni G, Pozzi C, Quaglini S, Segagni S, Banfi G, Baroli A, et al. Long-term prognosis of diffuse proliferative glomerulonephritis associated with infection in adults. Nephrol Dial Transplant. 2002;17(7):1204–11.

    Article  Google Scholar 

  20. Nagaba Y, Hiki Y, Aoyama T, Sano T, Matsuo T, Shimizu T, et al. Effective antibiotic treatment of methicillin-resistant Staphylococcus aureus-associated glomerulonephritis. Nephron 2002;92(2):297–303.

    Article  CAS  Google Scholar 

  21. Satoskar AA, Nadasdy G, Plaza JA, Sedmak D, Shidham G, Hebert L, et al. Staphylococcus infection-associated glomerulonephritis mimicking IgA nephropathy. Clin J Am Soc Nephrol. 2006;1(6):1179–86.

    Article  Google Scholar 

  22. Handa T, Ono T, Watanabe H, Takeda T, Muso E, Kita T. Glomerulonephritis induced by methicillin-sensitive Staphylococcus aureus infection. Clin Exp Nephrol. 2003;7(3):247–9.

    Article  Google Scholar 

  23. Nasr SH, Share DS, Vargas MT, D’Agati VD, Markowitz GS. Acute poststaphylococcal glomerulonephritis superimposed on diabetic glomerulosclerosis. Kidney Int. 2007;71(12):1317–21.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors are also grateful to Medical English Service for editing the paper.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eri Muso.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Informed consent

This was a retrospective study and used a preexisting database while employing the highest privacy policy standards. Therefore, the requirement of informed consent was waived.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 KB)

Supplementary material 2 (DOCX 20 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Handa, T., Kakita, H., Tateishi, Y. et al. The features in IgA-dominant infection-related glomerulonephritis distinct from IgA nephropathy: a single-center study. Clin Exp Nephrol 22, 1116–1127 (2018). https://doi.org/10.1007/s10157-018-1564-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-018-1564-4

Keywords

Navigation