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• W4212897789 abstract "The clinical and pathologic manifestations of infection-associated glomerulonephritis (IAGN) depends on the underlying infection and frequently results in persistent and irreversible kidney disease. We assessed the incidence of IAGN and aimed to identify clinical and pathologic characteristics that could be related with outcomes including response to steroid treatment (ST). Clinical and outcome data from patients >18y, with histologic and laboratory diagnosis of IAGN, were collected retrospectively between 2008 to 2020. Evidence of simultaneous infection was confirmed. Patient data was censured by death and renal replacement therapy (RRT) dependence through one year of follow-up. Fifteen out of 517 kidney biopsies performed (2.9%) met criteria of IAGN; 80% of patients were male, with mean age of 70±10y. All had history of hypertension; 33% were diabetic and 33% had alcoholic habits. At admission most presented hypertension and oedema; all developed kidney injury (mean eGFR 25.7mL/min) with haematuria and proteinuria (53% in nephrotic range). C3 levels were decreased in 60% and IgA levels were high in 40%. The commonest infection site was skin and Staphylococcus aureus was the most prevalent agent. Biopsies findings showed mesangial (87%) and endocapillary hypercellularity (93%) in an exudative pattern; 60% had cellular crescent formation. Immunofluorescence studies showed C3 staining in both mesangium and capillary loops (93%). IgA was the dominant or codominant immunoglobulin in 60% of cases (data related to IgA dominance in table 1). Regarding electron microscopy, 69.2% presented mesangial and subendothelial deposits; 46.2% had hump-type subepithelial deposits. All patients were treated with antibiotics; after infection eradication, 73.3% underwent ST because of persistence of severe kidney dysfunction (data related to ST in table 2). There were no identified pathologic findings associated with worse kidney outcomes. Overall IAGN patients, only 3 (20%) had total kidney recovery until the end of follow-up, whereas 4 presented partial recovery (27%) and 8 were considered no-recovery (53%); of them, half of patients died. Nine patients (60%) needed in-hospital RRT; of them, 2 died in-hospital, 4 remained in RRT and 3 had kidney recovery (data shown in table 3). View Large Image Figure ViewerDownload Hi-res image Download (PPT) Table 1 and 2. IAGN classified according IgA dominance in kidney biopsy (left) and according to ST (right). Kidney response measured by eGFR at discharge (D), 3 months (eGFR3) and 12 months of follow-up (eGFR12). RRT needed in-hospital (RRT-H) and during follow-up (RRT-F). Global partial or total (P/T) renal recovery by group. Table 3. IAGN patients classified according to recovery. eGFR at admission (A), discharge (D), 3 months (eGFR3) and 12 months of follow-up (eGFR12). RRT needed in-hospital (RRT-H) and during follow-up (RRT-F). Global partial or total (P/T) renal recovery. Our results correspond to a small series of a single center. The kidney biopsy incidence of IAGN was low but most of those patients had poor kidney outcomes, which seems not to be related with the presence of IgA dominance. ST did not improve kidney function, although it is important to highlight that all patients IS-treated had more severe disease. It seems that early diagnosis can be crucial for recovery. Future research in a larger cohort is needed to better understand risk factors for worse outcomes." @default.
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• W4212897789 date "2022-02-01" @default.
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• W4212897789 title "POS-113 INFECTION ASSOCIATED GLOMERULONEPHRITIS: IS IT ONLY RELATED TO INFECTION?" @default.
• W4212897789 doi "https://doi.org/10.1016/j.ekir.2022.01.125" @default.
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