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Infection related glomerulonephritis (IRGN) have an incidence in the kidney biopsy between 0.6% and 4.6% in developed countries, the infection could be in progress at moment to diagnosed, had sites of infection such as the skin, upper respiratory tract, heart, oral mucosa, teeth, and urinary tract, however, the subclinical presentation is at least four times more common than overt clinical disease.
Objective. A case of IRGN is presented with a rapidly progressive decline of the kidney function by means a urinary infectious condition with subsequent improvement after antibiotic treatment.
Clinical case presentation. 65 years old female, previously healthy, who presented edema of the lower extremities and dyspnea, with hypertension and rapidly progressive descent of renal function, basal creatinine 4.1 mg/dl and anuria two months before its admission for which hemodialysis was started, proteinuria of 9g/24hrs, elevated acute phase reactants and low C3 were identified. LES, rheumatoid arthritis, Sjogren’s and paraproteinemia were discarded. Among the studies carried out were negative viral panel, serum/urine electrophoresis without monoclonal peak, negative cryoglobulins, transthoracic echocardiogram (TTE) without vegetations, thoraco-abdomino-pelvic tomography without findings suggestive of neoplasms or infections, negative blood cultures, urine culture with Klebsiella pneumoniae extended spectrum beta lactamases (ESBLs) so carbapenem was started.
A Kidney biopsy was carried out reporting glomerulonephritis due to immune complexes with membranoproliferative pattern, focal fibrous active extracapillary ploriferation with hyaline thrombi, in IF with deposit of IgG (2+), C3c (2+) and Lambda (2+) with ME with subendothelial deposits, later presented recovery from uresis and currently with proteinuria of 1.2 g/24hrs. The catheter was removed with current creatinine 1.2mg/dl and normal C3.
Discussion. The diagnostic criteria and indications for kidney biopsy area: clinical or laboratory evidence of infection before or at the beginning of glomerulonephritis (GN), depressed serum complement, proliferative and exudative endocapillary GN, dominant glomerular C3 immunofluorescence, and hump-shaped subepithelial deposits in the electron microscopy, findings that were found in this case and which was a diagnostic challenge.
Kidney biopsy is recommended in most adults suspected of having IRGN to confirm the diagnosis and rule out other GN that have similar clinical presentations and may require rapid aggressive immunosuppressive therapy. In this case, it has been essential to find the cause because most are based on supportive treatments, in the case of infectious etiology the targeted treatment improved renal function in this patient.