Staphylococcal Infection–Related Glomerulonephritis With Cryoglobulinemic Features

Mazdak Khalighi, Laith Al-Rabadi, Meghana Chalasani, Mark Smith, Siddhartha Kakani, Monica P. Revelo, Shane M. Meehan

Research output: Contribution to journalArticle

Abstract

Introduction: Staphylococcal infection–related glomerulonephritis (GN) has been shown to represent a unique form of infection-related GN that contains IgA-dominant deposits and is often seen concurrently with the bacterial infection. Biopsies commonly reveal an endocapillary proliferative and/or exudative or mesangial proliferative GN. Rare cases have been reported to show cryoglobulin-like features, including hyaline pseudothrombi and wireloop deposits; however, detailed characterization of these cases is lacking. Methods: The pathology archives from the University of Utah and Sharp Memorial Hospital were reviewed from January 2016 to September 2017 in search of cases with GN containing IgA-dominant deposits and features of cryoglobulinemia. Results: Of 1965 native kidney biopsies, 5 showed IgA-dominant GN with cryoglobulinemic features. All patients had active staphylococcal infections at the time of biopsy. All presented with acute kidney injury (serum creatinine range: 1.7−6 mg/dl), and all had proteinuria and hematuria. All biopsies showed exudative GN, and 4 biopsies had focal crescents. All had focally prominent hyaline pseudothrombi with or without wireloop deposits, and all showed co-dominant staining for IgA and C3 on immunofluorescence microscopy. Serologic testing for cryoglobulinemia was performed in 3 patients and was transiently positive in 1 patient. Four patients required hemodialysis at last follow-up, whereas 1 patient returned to baseline kidney function. Conclusion: IgA-dominant GN with cryoglobulinemic features is an uncommon but severe form of glomerular injury in patients with staphylococcal infections. Four of 5 patients had crescentic glomerular injuries, all of whom required hemodialysis at last follow-up. Patients with IgA-dominant GN with features of cryoglobulinemia should be evaluated for active staphylococcal infection.

Original languageEnglish (US)
Pages (from-to)1128-1134
Number of pages7
JournalKidney International Reports
Volume3
Issue number5
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

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Glomerulonephritis
Immunoglobulin A
Cryoglobulinemia
Staphylococcal Infections
Biopsy
Hyalin
Renal Dialysis
Cryoglobulins
Kidney
Wounds and Injuries
Hematuria
Proteinuria
Fluorescence Microscopy
Bacterial Infections
Acute Kidney Injury
Creatinine
Pathology
Staining and Labeling
Infection
Serum

Keywords

  • acute kidney injury
  • cryoglobulinemia
  • infection-related glomerulonephritis

ASJC Scopus subject areas

  • Nephrology

Cite this

Khalighi, M., Al-Rabadi, L., Chalasani, M., Smith, M., Kakani, S., Revelo, M. P., & Meehan, S. M. (2018). Staphylococcal Infection–Related Glomerulonephritis With Cryoglobulinemic Features. Kidney International Reports, 3(5), 1128-1134. https://doi.org/10.1016/j.ekir.2018.05.010

Staphylococcal Infection–Related Glomerulonephritis With Cryoglobulinemic Features. / Khalighi, Mazdak; Al-Rabadi, Laith; Chalasani, Meghana; Smith, Mark; Kakani, Siddhartha; Revelo, Monica P.; Meehan, Shane M.

In: Kidney International Reports, Vol. 3, No. 5, 01.09.2018, p. 1128-1134.

Research output: Contribution to journalArticle

Khalighi, M, Al-Rabadi, L, Chalasani, M, Smith, M, Kakani, S, Revelo, MP & Meehan, SM 2018, 'Staphylococcal Infection–Related Glomerulonephritis With Cryoglobulinemic Features', Kidney International Reports, vol. 3, no. 5, pp. 1128-1134. https://doi.org/10.1016/j.ekir.2018.05.010
Khalighi, Mazdak ; Al-Rabadi, Laith ; Chalasani, Meghana ; Smith, Mark ; Kakani, Siddhartha ; Revelo, Monica P. ; Meehan, Shane M. / Staphylococcal Infection–Related Glomerulonephritis With Cryoglobulinemic Features. In: Kidney International Reports. 2018 ; Vol. 3, No. 5. pp. 1128-1134.
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AU - Smith, Mark

AU - Kakani, Siddhartha

AU - Revelo, Monica P.

AU - Meehan, Shane M.

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N2 - Introduction: Staphylococcal infection–related glomerulonephritis (GN) has been shown to represent a unique form of infection-related GN that contains IgA-dominant deposits and is often seen concurrently with the bacterial infection. Biopsies commonly reveal an endocapillary proliferative and/or exudative or mesangial proliferative GN. Rare cases have been reported to show cryoglobulin-like features, including hyaline pseudothrombi and wireloop deposits; however, detailed characterization of these cases is lacking. Methods: The pathology archives from the University of Utah and Sharp Memorial Hospital were reviewed from January 2016 to September 2017 in search of cases with GN containing IgA-dominant deposits and features of cryoglobulinemia. Results: Of 1965 native kidney biopsies, 5 showed IgA-dominant GN with cryoglobulinemic features. All patients had active staphylococcal infections at the time of biopsy. All presented with acute kidney injury (serum creatinine range: 1.7−6 mg/dl), and all had proteinuria and hematuria. All biopsies showed exudative GN, and 4 biopsies had focal crescents. All had focally prominent hyaline pseudothrombi with or without wireloop deposits, and all showed co-dominant staining for IgA and C3 on immunofluorescence microscopy. Serologic testing for cryoglobulinemia was performed in 3 patients and was transiently positive in 1 patient. Four patients required hemodialysis at last follow-up, whereas 1 patient returned to baseline kidney function. Conclusion: IgA-dominant GN with cryoglobulinemic features is an uncommon but severe form of glomerular injury in patients with staphylococcal infections. Four of 5 patients had crescentic glomerular injuries, all of whom required hemodialysis at last follow-up. Patients with IgA-dominant GN with features of cryoglobulinemia should be evaluated for active staphylococcal infection.

AB - Introduction: Staphylococcal infection–related glomerulonephritis (GN) has been shown to represent a unique form of infection-related GN that contains IgA-dominant deposits and is often seen concurrently with the bacterial infection. Biopsies commonly reveal an endocapillary proliferative and/or exudative or mesangial proliferative GN. Rare cases have been reported to show cryoglobulin-like features, including hyaline pseudothrombi and wireloop deposits; however, detailed characterization of these cases is lacking. Methods: The pathology archives from the University of Utah and Sharp Memorial Hospital were reviewed from January 2016 to September 2017 in search of cases with GN containing IgA-dominant deposits and features of cryoglobulinemia. Results: Of 1965 native kidney biopsies, 5 showed IgA-dominant GN with cryoglobulinemic features. All patients had active staphylococcal infections at the time of biopsy. All presented with acute kidney injury (serum creatinine range: 1.7−6 mg/dl), and all had proteinuria and hematuria. All biopsies showed exudative GN, and 4 biopsies had focal crescents. All had focally prominent hyaline pseudothrombi with or without wireloop deposits, and all showed co-dominant staining for IgA and C3 on immunofluorescence microscopy. Serologic testing for cryoglobulinemia was performed in 3 patients and was transiently positive in 1 patient. Four patients required hemodialysis at last follow-up, whereas 1 patient returned to baseline kidney function. Conclusion: IgA-dominant GN with cryoglobulinemic features is an uncommon but severe form of glomerular injury in patients with staphylococcal infections. Four of 5 patients had crescentic glomerular injuries, all of whom required hemodialysis at last follow-up. Patients with IgA-dominant GN with features of cryoglobulinemia should be evaluated for active staphylococcal infection.

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