Introduction:
Infection related glomerulonephritis is important glomerular disease. Data regarding treatment and outcome is scarce. We have done this study to see clinical patterns and outcomes of Infection related glomerulonephritis.
Methods:
Study was conducted in IMS BHU Varanasi. We retrospectively enrolled patients from January 2019 to January 2023 meeting criteria of IRGN. We used Diagnostic criteria for IRGN given by Nasr et al. in adults age more than 18 years. (1) Presence of infectious disease before or at the onset of glomerulonephritis, (2) hypocomplementemia, (3) endocapillary proliferative and exudative glomerulonephritis on optical microscopy of renal biopsy tissue, (4) C3-dominant deposits on immunofluorescence, and (5) presence of hump-like subepithelial deposits on electron microscopy. We included those patients having 3 out of above 5 criteria for diagnosis of IRGN as suggested by Nasr et al. All patients were treated according to institutional protocol; all patients outcome were followed for 1year.
Results:
We retrospectively analysed data of 25 patients with IRGN. We included patients from 18 to 65 years with mean age 40.48+/-14.5 years. Majority of them 15 (60%) were males. In our study population 4 were diabetics, 5 were hypertensive, 2 were post partum, 1 was with hypothyroidism and 1 was with COPD. On presentation 17 (68%) were with fever. On presentation 21 (84%) were with Edema. In our study population 4 (16%) had macroscopic hematuria and 20 had microscopic hematuria (80%). Table 1 depict syndrome at presentation.
Table 1 Syndrome at presentation
Focus of infection was identified in 9 patients which includes cellulitis in 1, Infective endocarditis in 1, 5 patient had LRTI, 3 had URTI and 1 had puerperal sepsis. 8 patients were dialysis dependent at presentation. Low complement ( c3 levels) were found in 19 patients (76%), Leucocytosis present in 19 (76%) patients with 18 (72%) neutrophilic predominance. On renal biopsy 14 (56%) had crescents with 4 patient’s more than 50% crescents. A diabetic patient had Ig A dominant IRGN. Most patients (60%) received conservative treatment. 3 patients non recovering renal injury received cyclophosphamide 2 of them eventually improved with treatment.
Table 2 Depicts therapy received
At 12 weeks 19 (76%) patients recovered completely while 5 (25%) had persistent renal dysfunction of which 2 were dialysis dependent and 1 patient had persistent proteinuria.
At end of 1 year 20 patients recovered completely, 2 were dialysis dependent, 2 had non dialysis requiring renal dysfunction and 1 had persistent proteinuria.
Conclusions:
Despite significant strides made in our understanding of the pathogenesis of IRGN, there remains a lack of specific therapeutic interventions. Previous studies failed to reach consensus regarding definitive management of IRGN especially patients with non recovering renal function and also patients with RPGN presentation and/or crescentric glomerulonephritis. In our study most patients recovered spontaneously with supportive care. 10 patients with crescents with non recovering renal function received steroid additionally cyclophosphamide was added in patients with non recovering renal function with RPGN presentation and with requirement of RRT and Crescents more than 50% on renal biopsy. Only 1 patient recovered with addition of cyclophosphamide other 2 remained dialysis dependent at end of 1 year. 3 out of 7 patients who received steroid had some renal dysfunction or proteinuria at end of 1 year.
Our study demonstrate that addition of steroid and immunosupression in most case do not play role in recovery in IRGN which re emphasize the studies done by previous investigators
Treatment of IRGN is currently supportive only. Treatment failures warrants investigation of new treatment options like complement inhibitor therapy as current add on therapy steroid and immunosupression do not alter outcomes in most of the cases.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.