The Spectrum of Adult Postinfectious Glomerulonephritis in the New Millennium

Figures & data

Table 1  Clinical details of 20 adult patients with postinfectious glomerulonephritis

Case number	Sex/age (year)	Infectious agent	Infectious origin	Time relationship between nephritis and infection	Peak serum creatinine (mg/dl)/ dialysis support	Proteinuria (g/24 h)	Hematuria (RBC/HPF)	Complement (mg/dl)	Follow-up (month)	Last serum creatinine (mg/dl)
1	M/31	MSSA	Endocarditis	During infection	9.8/Y	0.5	35 to 40	C3: 40.9	36	1.2
2	M/70	MRSA	Intra-abdominal abscess	During infection	9.4/Y	9.8	Numerous	Normal	3	Died
3	M/73	MRSA	Urinary tract infection	During infection	9.5/Y	>300 mg/dl	Numerous	Normal	1	Died
4	M/74	MSSA	Osteomyelitis of spine	During infection	11.8/Y	7.9	Numerous	Normal	4	Dialysis
5	F/72	Nontuberculosis mycobacterium	Pneumonia	During infection	5.7/Y	1.9	Numerous	Normal	3	Died
6	M/46	Streptococcus viridans	Endocarditis	During infection	11.1/Y	>300 mg/dl	Numerous	C3: 37.4	6	Dialysis
7	M/63	Streptococcus pyogenes	Intra-abdominal abscess	During infection	6.8/N	0.7	Numerous	C3: 39.6	74	2.6
8	F/66	Proteus mirabilis	Cellulitis of leg	During infection	1.7/N	2.1	Numerous	C3: 31.5	42	1.1
9	M/59	Streptococcus	Unknown	Post-infection	2.0/N	5.2	Numerous	C3: 25.7	15	1.2
10	M/55	Klebsiella pneumoniae	Urinary tract infection	During infection	8.9/Y	2.2	Numerous	C3: 31.9	1	Died
11	M/30	MSSA	Endocarditis	During infection	3.3/N	2.5	Numerous	C3: 26.0	41	0.9
12	F/75	MRSA	Lung abscess	During infection	3.3/Y	>300 mg/dl	Numerous	C3: 66.6	2	Died
13	F/70	Not available	Urinary tract infection	During infection	8.7/Y	4.8	35 to 40	Normal	36	Dialysis
14	M/45	MRSA	Endocarditis	During infection	2.8/N	3.8	20 to 30	C3: 65.9	68	0.8
15	M/80	MRSA	Central line infection	During infection	4.3/Y	3.3	Numerous	Normal	1	Died
16	F/70	MSSA	Osteomyelitis of spine	During infection	4.8/Y	1.2	Numerous	C3: 66.0	25	2.6
17	M/73	Mycobacterium tuberculosis	Pneumonia	During infection	8.8/Y	0.6	Numerous	Normal	12	4.1
18	M/44	MRSA	Septic arthritis of hip	During infection	9.6/N	2.9	Numerous	C3: 70.5	5	1.9
19	F/65	MRSA	Infected surgical wound	During infection	3.0/N	1.5	Numerous	C3: 52.0	10	1.0
20	M/57	MRSA	Infected diabetic foot	During infection	7.7/Y	3.0	Numerous	Normal	4	Dialysis

*Normal range: C3, 72–136 mg/dl; C4, 12–47 mg/dl.

Abbreviations: M = male, F = female, MSSA = methicillin-sensitive Staphylococcus aureus, MRSA = methicillin-resistant Staphylococcus aureus, MSSE = methicillin-sensitive Staphylococcus epidermidis.

Table 2  Histological features of 20 adult patients with postinfectious glomerulonephritis

Case number	Light microscopy	Immunofluorescence	Electron microscopy
1	Diffuse endocapillary proliferative GN with neutrophils, acute tubular necrosis, tubular atrophy 1+	C3 (1+); GCW	Not available
2	Diffuse endocapillary proliferative GN with 50% cellular crescents, acute tubular necrosis, interstitial infiltration 3+, tubular atrophy 1+	IgA (1+), IgG (1+), C3 (3+); MES	Not available
3	Diffuse endocapillary proliferative GN with neutrophils and 50% cellular crescents, glomerular fibrinoid necrosis 1+, interstitial infiltration 1+, interstitial fibrosis 1+, tubular atrophy 1+	IgA (2+), IgG (1+), C3 (2+); GCW	Not available
4	Diffuse endocapillary proliferative GN with 30% cellular crescents, acute tubular necrosis, interstitial infiltration 3+, tubular atrophy 1+	IgA (1+), IgG (1+), C3 (1+); MES	Not available
5	Diffuse endocapillary proliferative GN with neutrophils and 40% cellular crescents, acute tubular necrosis, interstitial infiltration 3+, tubular atrophy 1+	IgA (1+), IgG (1+), C3 (2+), C1q (1+); MES/GCW	Subendothelial and mesangial deposits
6	Diffuse endocapillary proliferative GN with 100% cellular crescents, acute tubular necrosis, interstitial infiltration 3+	IgM (1+), C3 (2+), C1q (1+); GCW	Not available
7	Diffuse endocapillary proliferative GN with neutrophils, interstitial infiltration 3+, interstitial fibrosis 1+, tubular atrophy 1+	C3 (1+); MES/GCW	Not available
8	Diffuse endocapillary and focal mesangial proliferative GN with neutrophils, interstitial infiltration 1+, interstitial fibrosis 1+, tubular atrophy 1+	C3 (1+); GCW	Subendothelial and mesangial deposits, subepithelial humps
9	Diffuse endocapillary proliferative GN with neutrophils, interstitial infiltration 1+, interstitial fibrosis 1+	IgA (2+), IgG (1+), IgM (2+), C3 (3+), C1q (2+); GCW	Subendothelial and mesangial deposits, subepithelial humps
10	Diffuse endocapillary proliferative GN with neutrophils and 35% cellular crescents, acute tubular necrosis, interstitial infiltration 3+, tubular atrophy 1+	IgA (1+), IgM (1+), C3 (2+), C1q (2+); GCW	Not available
11	Diffuse endocapillary proliferative GN with neutrophils	IgA (1+), IgG (1+), IgM (1+), C3 (2+), C1q (1+); GCW	Subendothelial and mesangial deposits, subepithelial humps
12	Diffuse endocapillary proliferative GN with neutrophils, acute tubular necrosis, interstitial infiltration 3+	IgA (2+), IgG (1+), C3 (2+); GCW	Not available
13	Diffuse endocapillary proliferative GN with neutrophils and 60% cellular crescents, acute tubular necrosis, interstitial infiltration 3+, tubular atrophy 1+	IgG (1+), IgM (1+), C3 (2+), C1q (1+); MES/GCW	Not available
14	Focal mesangial proliferative GN, interstitial infiltration 1+	IgA (2+), IgG (1+), C3 (2+);	Mesangial deposits
15	Focal mesangial proliferative GN, acute tubular necrosis, interstitial infiltration 1+, interstitial fibrosis 1+, tubular atrophy 1+	IgA (2+), IgG (1+); MES	Mesangial deposits
16	Focal mesangial proliferative GN, diabetic glomerulosclerosis, acute tubular necrosis, interstitial infiltration 1+, tubular atrophy 1+	IgA (2+), IgG (1+), IgM (1+), C3 (2+), C1q (1+); MES	Mesangial deposits
17	Focal mesangial proliferative GN with neutrophils and 10% cellular crescents, acute tubular necrosis, interstitial infiltration 3+, tubular atrophy 1+	IgA (1+), IgG (1+), IgM (1+), C3 (2+); MES	Mesangial deposits, subepithelial humps
18	Focal mesangial proliferative GN with 30% cellular crescents, acute tubular necrosis, interstitial infiltration 1+, tubular atrophy 1+	IgA (1+), IgG (1+), IgM (1+), C3 (1+); MES/GCW	Mesangial deposits
19	Focal mesangial proliferative GN, interstitial infiltration 1+, tubular atrophy 1+	IgA (2+), IgG (1+), IgM (1+), C3 (2+); MES	Mesangial deposits
20	Focal mesangial proliferative GN, acute tubular necrosis, interstitial infiltration 3+, tubular atrophy 1+	IgA (2+), C3 (2+), C1q (1+); MES	Mesangial deposits

Abbreviations: GN = glomerulonephritis, GCW = glomerular capillary wall, MES = mesangial.

Table 3  Comparison of clinicopathological features between diffuse endocapillary and focal mesangial proliferative glomerulonephritis associated with infection in adults

Variables	Diffuse endocapillary proliferative GN (n = 13), mean ± SD or number (%)	Focal mesangial proliferative GN (n = 7), mean ± SD or number (%)	p
Age (years)	60 ± 16	62 ± 14
Gender (male/female)	9/4	5/2
Proteinuria (g/24 h)	3.8 ± 3.1	2.3 ± 1.2	0.558
Hematuria	12 (100)	6 (100)
C3 (mg/dl)	56.6 ± 28.3	79.6 ± 21.2	0.122
C4 (mg/dl)	20.1 ± 8.1	23.4 ± 10.0	0.362
Glomerular crescents (%)	28 ± 32	8 ± 11	0.118
Glomerular neutrophil infiltration^†	10 (77)	1 (14)	0.017
Acute tubular necrosis	8 (62)	5 (71)
Interstitial infiltration (2+ or 3+)^†	8 (62)	2 (29)	0.350
Subepithelial humps	3 (23)	1 (14)
Dialysis support requirement^†	9 (69)	4 (57)	0.651
Death^†	5 (38)	1 (14)	0.354
Remission in survivors^†	5/8 (63)	5/6 (83)	0.580
Complete remission	4/8 (50)	2/6 (33)	0.627
Partial remission	1/8 (13)	3/6 (50)	0.245
Long-term dialysis in survivors^†	3/8 (38)	1/6 (17)	0.580

*Data were analyzed by Mann-Whitney U test.

^†Data were analyzed by Fisher's exact test.

Abbreviation: GN = glomerulonephritis.

Figure 1.  Percentage of patients with diffuse endocapillary proliferative glomerulonephritis and patients with focal mesangial proliferative glomerulonephritis in different time periods.