Favorable Outcome of Crescentic IgA Nephropathy Associated with Methicillin-Resistant Staphylococcus aureus Infection

Figures & data

Figure 1. Glomerulus showing mesangial proliferation with cellular crescent formation (periodic acid–Schiff stain, ×400).

Figure 2. Immunofluorescence staining for IgA showing 2+ granular deposition in mesangium and glomerular capillary loops (original magnification ×400); there is also 2+ staining for C3 in a similar pattern (not shown).

Figure 3. Electron microscopy showing electron-dense deposits in the mesangium (original magnification ×8000).

Table 1. Clinical characteristics of patients with crescentic IgA nephropathy associated with staphylococcal infection described in the literature

Case number	Age (year)/gender	Staphylococcus species	Source of infection	Predisposing factor	Interval from infection to renal signs	Creatinine at biopsy (mg/dL)	Proteinuria (g/24 h)	Hematuria (RBC/HPF)	Decreased complementlevels	Immunosuppressive therapy	Renal outcome
1 (Nagaba et al.^9)	73/M	MRSA	Pneumonia	Malignancy	6 weeks	2.5	2.8	OB++	No	None	Improved
2 (Nagaba et al.^9)	35/F	MRSA	Skin abscess	None	16 weeks	0.6	2.0	OB+++	No	None	Improved
3 (Nagaba et al.^9)	67/M	MRSA	Aortic graft infection	Aortic aneurysm	4 weeks	5.2	4.2	OB++	No	None	Improved
4 (Nagaba et al.^9)	54/M	MRSA	Intra-abdominal abscess	Malignancy	8 weeks	1.2	2.2	OB+++	No	PN	Improved^a
5 (Nagaba et al.^9)	23/M	MRSA	Skin infection	Psoriasis	12 weeks	2.4	8.5	OB+++	Yes	MPP/PN	Improved^b
6 (Kai et al.^12)	48/M	MRSA	Pneumonia	Malnutrition	2 weeks	1.2	NA	20–30	No	MPP/PN	Improved
7 (Hashimoto et al.^15)	28/F	MRSA	Postpartum vaginal infection	None	NA	1.5	11	>100	No	MPP/PN	Improved
8 (Zeledon et al.^18)	71/M	MRSA	Infected surgical wound	None	NA	2.7	3.9	>100	No	MPP/PN/CY	Improved
9 (Riley et al.^19)	64/M	MRSA	Chronic osteomyelitis of feet	Diabetes	NA	6.1	5.3	>100	No	None	Improved
10 (our case)	57/M	MRSA	Septic arthritis of hip	None	4 weeks	6.4	2.9	>100	Yes	MPP/PN	Improved

Notes: M, male; F, female; MRSA, methicillin-resistant Staphylococcus aureus; RBC, red blood cell; HPF, high-power field; OB, occult blood; NA, not available; MPP, methylprednisolone pulse therapy; PN, prednisone; CY, cyclophosphamide.

^aDied of sepsis 4 months after starting corticosteroid therapy.

^bDied of cerebral bacterial embolism 4 months after starting corticosteroid therapy.

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