Staphylococcus-associated glomerulonephritis - Revision history

Aidan: /* Clinical Manifestations */

2021-03-06T15:54:51Z

Clinical Manifestations

← Older revision		Revision as of 15:54, 6 March 2021
Line 1:		Line 1:
	{{DISPLAYTITLE:''Staphylococcus''-associated glomerulonephritis}}		{{DISPLAYTITLE:''Staphylococcus''-associated glomerulonephritis}}

	== Background ==		==Background==

	*A form of [[infection-associated glomerulonephritis]] caused by infection with [[Staphylococcus aureus]] or [[Staphylococcus epidermidis]]		*A form of [[infection-associated glomerulonephritis]] caused by infection with [[Staphylococcus aureus]] or [[Staphylococcus epidermidis]]
	*Occurs during acute infection (unlike [[post-streptococcal glomerulonephritis]], which occurs following resolved infection)		*Occurs during acute infection (unlike [[post-streptococcal glomerulonephritis]], which occurs following resolved infection)

	=== Pathophysiology ===		===Pathophysiology===

	* IgA-mediated immune complex deposition		*IgA-mediated immune complex deposition

	=== Epidemiology ===		===Epidemiology===

	* Originally described with [[Staphylococcus epidermidis]] ventriculo-atrial shunt infections or endocarditis		*Originally described with [[Staphylococcus epidermidis]] ventriculo-atrial shunt infections or endocarditis
	* Now mostly caused by [[Staphylococcus aureus]]		*Now mostly caused by [[Staphylococcus aureus]]
	* Most commonly occurs in older patients 40 to 60 years old, and people who inject drugs		*Most commonly occurs in older patients 40 to 60 years old, and people who inject drugs

	== Clinical Manifestations ==		==Clinical Manifestations==

	* Glomerulonephritis that occurs during an acute staphylococcal infection		*Glomerulonephritis that occurs during an acute staphylococcal infection
	** [[AKI]], [[microscopic hematuria]], and nephrotic-range [[proteinuria]]		**Syndrome characterized by [[AKI]], [[microscopic hematuria]], and nephrotic-range [[proteinuria]]
		⚫	**May be associated with any infection, including [[skin and soft tissue infection]], [[abscess]], [[osteomyelitis]], [[endocarditis]], [[intra-abdominal infection]], and [[dental abscess]]
	* Some patients have concurrent [[leukocytoclastic vasculitis]] similar to [[Henoch-Schönlein purpura]]		*Some patients have concurrent [[leukocytoclastic vasculitis]] similar to [[Henoch-Schönlein purpura]]
⚫	* May be associated with any infection, including [[skin and soft tissue infection]], [[abscess]], [[osteomyelitis]], [[endocarditis]], [[intra-abdominal infection]], and [[dental abscess]]
	* Laboratory findings include occasional ANCA positivity (usually low titres), often low C3 with normal C4 (but both may be normal)		*Laboratory findings include occasional ANCA positivity (usually low titres), often low C3 with normal C4 (but both may be normal)

	=== Complications and Prognosis ===		===Complications and Prognosis===

	* [[Chronic kidney disease]] in 40 to 77%, with 43% progressing to [[end-stage renal disease]]		*[[Chronic kidney disease]] in 40 to 77%, with 43% progressing to [[end-stage renal disease]]

	== Diagnosis ==		==Diagnosis==

	=== Diagnostic Criteria ===		===Diagnostic Criteria===

	==== Definitive Diagnosis ====		====Definitive Diagnosis====

	* Culture-proven staphylococcal infection (ongoing or recent)		*Culture-proven staphylococcal infection (ongoing or recent)
	* Acute-onset proliferative glomerulonephritis with IgA- and complement C3-containing glomerular immune complex deposites, acute kidney injury, nephrotic-range proteinuria, and hematuria		*Acute-onset proliferative glomerulonephritis with IgA- and complement C3-containing glomerular immune complex deposites, acute kidney injury, nephrotic-range proteinuria, and hematuria

	==== Additional Criteria ====		====Additional Criteria====

	* Presence of risk factors for infection: [[diabetes mellitus]], [[intravenous drug use]], recent surgical or invasive procedure, prosthetic devices such as pacemakers, heart valves or orthopaedic devices, poor dentition or tooth abscesses, multiple trauma with open wounds, non-healing ulcers or post-amputation wounds in diabetic patients, indwelling central or peripheral intravenous catheters or ventriculo-peritoneal shunt		*Presence of risk factors for infection: [[diabetes mellitus]], [[intravenous drug use]], recent surgical or invasive procedure, prosthetic devices such as pacemakers, heart valves or orthopaedic devices, poor dentition or tooth abscesses, multiple trauma with open wounds, non-healing ulcers or post-amputation wounds in diabetic patients, indwelling central or peripheral intravenous catheters or ventriculo-peritoneal shunt
	* Low serum C3 levels		*Low serum C3 levels
	* Leukocytoclastic vasculitic rash (often has IgA staining on biopsy)		*Leukocytoclastic vasculitic rash (often has IgA staining on biopsy)
	* Positive ANCA serology, though may be only mildly elevated		*Positive ANCA serology, though may be only mildly elevated
	* Predominant C3 immunofluorescence with or without IgA staining in the mesangial and capillary walls with electron-dense immune deposits on ultrastructural examination		*Predominant C3 immunofluorescence with or without IgA staining in the mesangial and capillary walls with electron-dense immune deposits on ultrastructural examination
	* Subepithelial humps seen with electron microscopy		*Subepithelial humps seen with electron microscopy

	== Management ==		==Management==

	* Treat the underlying infection		*Treat the underlying infection
	* Supportive care for the symptoms of acute nephritis		*Supportive care for the symptoms of acute nephritis
	** Hypertension: [[calcium channel blockers]] preferred, but can also use ACEi or ARBs		**Hypertension: [[calcium channel blockers]] preferred, but can also use ACEi or ARBs
	** Fluid overload: diuresis and salt restriction		**Fluid overload: diuresis and salt restriction
	** May need dialysis		**May need dialysis
	* Avoid immunosuppression		*Avoid immunosuppression

	==Further Reading==		==Further Reading==

Aidan at 01:08, 22 February 2021

2021-02-22T01:08:27Z

← Older revision		Revision as of 01:08, 22 February 2021
Line 1:		Line 1:
	{{DISPLAYTITLE:''Staphylococcus''-associated glomerulonephritis}}		{{DISPLAYTITLE:''Staphylococcus''-associated glomerulonephritis}}

			== Background ==
⚫	* A form of [[infection-associated glomerulonephritis]] caused by infection with [[Staphylococcus aureus]] or [[Staphylococcus epidermidis]]

		⚫	*A form of [[infection-associated glomerulonephritis]] caused by infection with [[Staphylococcus aureus]] or [[Staphylococcus epidermidis]]
⚫	== Further Reading ==
			*Occurs during acute infection (unlike [[post-streptococcal glomerulonephritis]], which occurs following resolved infection)

			=== Pathophysiology ===
⚫	* Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. ''Nat Rev Nephrol''. 2020;16(1):32-50. doi: [https://doi.org/10.1038/s41581-019-0178-8 10.1038/s41581-019-0178-8]

			* IgA-mediated immune complex deposition

			=== Epidemiology ===

			* Originally described with [[Staphylococcus epidermidis]] ventriculo-atrial shunt infections or endocarditis
			* Now mostly caused by [[Staphylococcus aureus]]
			* Most commonly occurs in older patients 40 to 60 years old, and people who inject drugs

			== Clinical Manifestations ==

			* Glomerulonephritis that occurs during an acute staphylococcal infection
			** [[AKI]], [[microscopic hematuria]], and nephrotic-range [[proteinuria]]
			* Some patients have concurrent [[leukocytoclastic vasculitis]] similar to [[Henoch-Schönlein purpura]]
			* May be associated with any infection, including [[skin and soft tissue infection]], [[abscess]], [[osteomyelitis]], [[endocarditis]], [[intra-abdominal infection]], and [[dental abscess]]
			* Laboratory findings include occasional ANCA positivity (usually low titres), often low C3 with normal C4 (but both may be normal)

			=== Complications and Prognosis ===

			* [[Chronic kidney disease]] in 40 to 77%, with 43% progressing to [[end-stage renal disease]]

			== Diagnosis ==

			=== Diagnostic Criteria ===

			==== Definitive Diagnosis ====

			* Culture-proven staphylococcal infection (ongoing or recent)
			* Acute-onset proliferative glomerulonephritis with IgA- and complement C3-containing glomerular immune complex deposites, acute kidney injury, nephrotic-range proteinuria, and hematuria

			==== Additional Criteria ====

			* Presence of risk factors for infection: [[diabetes mellitus]], [[intravenous drug use]], recent surgical or invasive procedure, prosthetic devices such as pacemakers, heart valves or orthopaedic devices, poor dentition or tooth abscesses, multiple trauma with open wounds, non-healing ulcers or post-amputation wounds in diabetic patients, indwelling central or peripheral intravenous catheters or ventriculo-peritoneal shunt
			* Low serum C3 levels
			* Leukocytoclastic vasculitic rash (often has IgA staining on biopsy)
			* Positive ANCA serology, though may be only mildly elevated
			* Predominant C3 immunofluorescence with or without IgA staining in the mesangial and capillary walls with electron-dense immune deposits on ultrastructural examination
			* Subepithelial humps seen with electron microscopy

			== Management ==

			* Treat the underlying infection
			* Supportive care for the symptoms of acute nephritis
			** Hypertension: [[calcium channel blockers]] preferred, but can also use ACEi or ARBs
			** Fluid overload: diuresis and salt restriction
			** May need dialysis
			* Avoid immunosuppression

		⚫	==Further Reading==

		⚫	*Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. ''Nat Rev Nephrol''. 2020;16(1):32-50. doi: [https://doi.org/10.1038/s41581-019-0178-8 10.1038/s41581-019-0178-8]

	[[Category:Glomerulonephritides]]		[[Category:Glomerulonephritides]]

Aidan: Created page with "{{DISPLAYTITLE:''Staphylococcus''-associated glomerulonephritis}} * A form of infection-associated glomerulonephritis caused by infection with Staphylococcus aureus o..."

2021-02-22T00:52:35Z

Created page with "{{DISPLAYTITLE:''Staphylococcus''-associated glomerulonephritis}} * A form of infection-associated glomerulonephritis caused by infection with Staphylococcus aureus o..."

New page

{{DISPLAYTITLE:''Staphylococcus''-associated glomerulonephritis}}

* A form of [[infection-associated glomerulonephritis]] caused by infection with [[Staphylococcus aureus]] or [[Staphylococcus epidermidis]]

== Further Reading ==

* Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. ''Nat Rev Nephrol''. 2020;16(1):32-50. doi: [https://doi.org/10.1038/s41581-019-0178-8 10.1038/s41581-019-0178-8]

[[Category:Glomerulonephritides]]
[[Category:Infectious syndromes]]