Staphylococcal Infection–Related Glomerulonephritis With Cryoglobulinemic Features

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

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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 2018

Keywords

  • acute kidney injury
  • cryoglobulinemia
  • infection-related glomerulonephritis

ASJC Scopus subject areas

  • Ophthalmology
  • Nephrology

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