Letter to the Editor
IgA-dominant infection-related glomerulonephritis
Glomerulonefritis relacionada con la infección por IgA-Dominante
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class="elsevierStyleTextfn">Letter to the Editor: Images in Nephrology</span>" "titulo" => "Triple functioning renal allograft after repeated liver–kidney transplantation due to liver failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "667" "paginaFinal" => "669" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Funcionamiento de un triple trasplante renal alogénico tras repetir un trasplante de hígado-riñón por fallo hepático" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2707 "Ancho" => 2417 "Tamanyo" => 552568 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">99m</span>Tc-MAG<span class="elsevierStyleInf">3</span> renogram curves were generated after drawing whole-kidney and background regions of interest for each renal transplant. The results obtained were expressed as the maximum count ratios: 200 cps (A), 117 cps (B) and 1640 cps (C), respectively. The relative differential function showed the following distribution of 16% for the right medial graft (A), 9% for the left graft (B) and 75% for the right lateral graft (C).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andrés Tapias, Nuria Sánchez, José V. Torregrosa, David Fuster, Pilar Perlaza, Francisco Lomeña" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Andrés" "apellidos" => "Tapias" ] 1 => array:2 [ "nombre" => "Nuria" "apellidos" => "Sánchez" ] 2 => array:2 [ "nombre" => "José V." "apellidos" => "Torregrosa" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Fuster" ] 4 => array:2 [ "nombre" => "Pilar" "apellidos" => "Perlaza" ] 5 => array:2 [ "nombre" => "Francisco" "apellidos" => "Lomeña" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0211699517302473" "doi" => "10.1016/j.nefro.2017.11.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517302473?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418300634?idApp=UINPBA000064" "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418300634/v1_201812140610/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "IgA-dominant infection-related glomerulonephritis" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "669" "paginaFinal" => "670" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Yoshinosuke Shimamura, Takuto Maeda, Yufu Gocho, Yayoi Ogawa, Hideki Takizawa" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Yoshinosuke" "apellidos" => "Shimamura" "email" => array:1 [ 0 => "yshimamura.tkh@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Takuto" "apellidos" => "Maeda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Yufu" "apellidos" => "Gocho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Yayoi" "apellidos" => "Ogawa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Hideki" "apellidos" => "Takizawa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hokkaido Renal Pathology Center, Sapporo, Hokkaido, Japan" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Glomerulonefritis relacionada con la infección por IgA-Dominante" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1134 "Ancho" => 900 "Tamanyo" => 143420 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Renal biopsy (IgA immunofluorescence, ×400), showing bright and coarsely granular staining in the glomeruli.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute post-infectious glomerulonephritis is an immune complex-mediated glomerulonephritis that classically occurs in children following streptococcal upper respiratory or skin infections. However, cases of IgA-dominant infection-related glomerulonephritis (IgA-IRGN), a diffuse endocapillary proliferative glomerulonephritis associated with intense IgA deposits following staphylococcus infection, have been increasingly reported in recent literature. In contrast to typical acute post-infectious glomerulonephritis, the causative infection is ongoing at the time of diagnosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> It often occurs in diabetic elderly patients and presents with acute kidney injury and heavy proteinuria. The prognosis is unfavourable. Here, we report an elderly-male patient with IgA-IGRN who demonstrated vasculitic skin rash.</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 80-year-old Japanese man with stage G3a chronic kidney disease due to diabetes mellitus was admitted to the general medicine service for management of right haemopneumothorax after a motor vehicle accident and subsequent empyema caused by methicillin-sensitive <span class="elsevierStyleItalic">Staphylococcus aureus</span> treated with four weeks of intravenous cefazolin and drainage. The patient was seen in nephrology consultation for a rise in serum creatinine level from 1.4<span class="elsevierStyleHsp" style=""></span>mg/dl upon admission to 5.3<span class="elsevierStyleHsp" style=""></span>mg/dl (estimated glomerular filtration rate of 9<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>) and purpuric lesions on the bilateral lower extremities. At the general medicine service, oral glucocorticoid was initiated for a presumed diagnosis of IgA vasculitis (Henoch-Schönlein purpura). However, the kidney function continued to worsen, and oliguria ensued despite infusion of lactated ringer's solution. Upon physical examination, he was not in distress. The blood pressure was 110/78<span class="elsevierStyleHsp" style=""></span>mmHg. There were trace pretibial oedema and purpuric lesions on the bilateral legs. Urinalysis showed >100 red blood cells per high-power field (70% dysmorphic) and 5.2<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h of proteinuria. Immunological analysis showed that increased immunoglobulins (IgG 1427<span class="elsevierStyleHsp" style=""></span>mg/dl; IgA 1373<span class="elsevierStyleHsp" style=""></span>mg/dl; IgM 48<span class="elsevierStyleHsp" style=""></span>mg/dl) and decreased complement levels (C3 77<span class="elsevierStyleHsp" style=""></span>mg/dl; C4 30<span class="elsevierStyleHsp" style=""></span>mg/dl; CH50 44<span class="elsevierStyleHsp" style=""></span>IU/ml). Antinuclear antibodies, antimyeloperoxidase antibodies, antiproteinase 3 antibodies, and a glomerular basement membrane antibody were negative. Renal biopsy showed 10 glomeruli, 4 of them sclerosed and 2 with endocapillary proliferation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was a mild interstitial infiltrate of polymorphonuclear cells, and the arteries had no significant lesions. Immunofluorescence microscopy showed diffuse depositions of IgA (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and C3. Electron microscopy could not be performed because of insufficient specimens. Based on clinical features and pathologic findings, IgA-IRGN was diagnosed. Intravenous cefazolin was administered for another four weeks, and oral glucocorticoid was tapered and stopped gradually without relapse of infection. However, the patient progressed to end-stage kidney disease even after 20<span class="elsevierStyleHsp" style=""></span>mg of olmesartan was initiated.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">IgA-IRGN is a morphologic variant of acute postinfectious glomerulonephritis mainly associated with staphylococcal infection, low serum complement, and underlying diabetic nephropathy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> At least three of the following criteria are required for diagnosis: clinical or laboratory evidence of infection preceding or at the onset of glomerulonephritis; depressed serum complement; endocapillary proliferative and exudative glomerulonephritis; C3-dominant or co-dominant glomerular immunofluorescence staining; and hump-shaped subepithelial deposits on electron microscopy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> The patient fulfilled four of the criteria. The mainstays of treatment are eradication of infection and management of nephritis, but the role of steroids is controversial. The prognosis is unfavourable, and 23% of patients progressed to dialysis-dependent end-stage kidney disease.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">IgA vasculitis should be differentiated from IgA-IRGN, but it may be difficult on morphologic grounds because endocapillary hypercellularity is common in IgA vasculitis. Clinical features that favour IgA vasculitis over IgA-IRGN include purpura, arthritis, abdominal pain and gastrointestinal bleeding, and the presence of normal serum complement levels.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> However, vasculitic skin rash can be observed in patients with IgA-IRGN. One research reported that 18% of patients with IgA-IRGN had purpura,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> and another reported that IgA-IRGN may have IgA vasculitis-like lower extremity purpuric lesion.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Our patient was diagnosed with IgA-IRGN because of the absence of arthritis, abdominal pain, gastrointestinal bleeding, and decreased complement levels.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical approval</span><p id="par0025" class="elsevierStylePara elsevierViewall">All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number: 2017-107) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all individual participants included in the study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical approval" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 878 "Ancho" => 900 "Tamanyo" => 202242 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Renal biopsy (haematoxylin and eosin, ×400), showing endocapillary hypercellularity with immune cell infiltration (<span class="elsevierStyleItalic">arrow head</span>).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1134 "Ancho" => 900 "Tamanyo" => 143420 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Renal biopsy (IgA immunofluorescence, ×400), showing bright and coarsely granular staining in the glomeruli.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathologic features of IgA-dominant infection-associated glomerulonephritis: a pooled analysis of 78 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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D’Agati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000324180" "Revista" => array:6 [ "tituloSerie" => "Nephron Clin Pract" "fecha" => "2011" "volumen" => "119" "paginaInicial" => "c18" "paginaFinal" => "c26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21659781" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The current spectrum of infectious glomerulonephritis. Experience with 76 patients and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Montseny" 1 => "A. Meyrier" 2 => "D. Kleinknecht" 3 => "P. Callard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "1995" "volumen" => "74" "paginaInicial" => "63" "paginaFinal" => "72" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Henoch-Schonlein purpura-like presentation in IgA-dominant staphylococcal infection-associated glomerulonephritis – a diagnostic pitfall" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.A. Satoskar" 1 => "M. Molenda" 2 => "P. Scipio" 3 => "R. Shim" 4 => "M. Zirwas" 5 => "R.S. Variath" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5414/CN107756" "Revista" => array:6 [ "tituloSerie" => "Clin Nephrol" "fecha" => "2013" "volumen" => "79" "paginaInicial" => "302" "paginaFinal" => "312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23320971" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418301305/v1_201812140610/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003800000006/v1_201812140610/S2013251418301305/v1_201812140610/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301305?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 13 | 23 |
| 2024 October | 48 | 38 | 86 |
| 2024 September | 69 | 40 | 109 |
| 2024 August | 62 | 63 | 125 |
| 2024 July | 58 | 32 | 90 |
| 2024 June | 87 | 59 | 146 |
| 2024 May | 70 | 31 | 101 |
| 2024 April | 49 | 38 | 87 |
| 2024 March | 38 | 29 | 67 |
| 2024 February | 43 | 35 | 78 |
| 2024 January | 40 | 34 | 74 |
| 2023 December | 37 | 21 | 58 |
| 2023 November | 44 | 34 | 78 |
| 2023 October | 55 | 32 | 87 |
| 2023 September | 60 | 37 | 97 |
| 2023 August | 66 | 27 | 93 |
| 2023 July | 62 | 30 | 92 |
| 2023 June | 71 | 17 | 88 |
| 2023 May | 111 | 26 | 137 |
| 2023 April | 36 | 21 | 57 |
| 2023 March | 88 | 15 | 103 |
| 2023 February | 49 | 16 | 65 |
| 2023 January | 51 | 39 | 90 |
| 2022 December | 80 | 24 | 104 |
| 2022 November | 53 | 39 | 92 |
| 2022 October | 114 | 39 | 153 |
| 2022 September | 70 | 44 | 114 |
| 2022 August | 48 | 44 | 92 |
| 2022 July | 51 | 52 | 103 |
| 2022 June | 45 | 53 | 98 |
| 2022 May | 80 | 28 | 108 |
| 2022 April | 78 | 52 | 130 |
| 2022 March | 84 | 54 | 138 |
| 2022 February | 78 | 49 | 127 |
| 2022 January | 95 | 42 | 137 |
| 2021 December | 62 | 52 | 114 |
| 2021 November | 71 | 46 | 117 |
| 2021 October | 123 | 51 | 174 |
| 2021 September | 66 | 45 | 111 |
| 2021 August | 89 | 43 | 132 |
| 2021 July | 105 | 36 | 141 |
| 2021 June | 356 | 31 | 387 |
| 2021 May | 169 | 89 | 258 |
| 2021 April | 139 | 80 | 219 |
| 2021 March | 64 | 43 | 107 |
| 2021 February | 24 | 32 | 56 |
| 2021 January | 32 | 29 | 61 |
| 2020 December | 32 | 15 | 47 |
| 2020 November | 33 | 25 | 58 |
| 2020 October | 40 | 22 | 62 |
| 2020 September | 35 | 12 | 47 |
| 2020 August | 34 | 18 | 52 |
| 2020 July | 31 | 19 | 50 |
| 2020 June | 36 | 12 | 48 |
| 2020 May | 39 | 19 | 58 |
| 2020 April | 21 | 17 | 38 |
| 2020 March | 42 | 21 | 63 |
| 2020 February | 56 | 18 | 74 |
| 2020 January | 70 | 22 | 92 |
| 2019 December | 59 | 24 | 83 |
| 2019 November | 61 | 31 | 92 |
| 2019 October | 49 | 25 | 74 |
| 2019 September | 42 | 30 | 72 |
| 2019 August | 32 | 17 | 49 |
| 2019 July | 47 | 46 | 93 |
| 2019 June | 50 | 29 | 79 |
| 2019 May | 48 | 19 | 67 |
| 2019 April | 75 | 44 | 119 |
| 2019 March | 39 | 28 | 67 |
| 2019 February | 19 | 22 | 41 |
| 2019 January | 36 | 39 | 75 |
| 2018 December | 29 | 44 | 73 |
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