Kidney Week

Abstract: PUB376

Postinfectious Glomerulonephritis Secondary to Pathological Puerperium

Session Information

• Publication Only

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Navarro Blackaller, Guillermo, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Guillermo Navarro Blackaller, MD

• Ornelas Ruvalcaba, Rebeca Lizette, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Rebeca Lizette Ornelas Ruvalcaba, MD

• Chavez, Jonathan, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Jonathan Chavez, PhD

• Garcia-Garcia, Guillermo, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Guillermo Garcia-Garcia, MD, FASN

• Cabrera Aguilar, Jose Said, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Jose Said Cabrera Aguilar, MD

• Langarica López, Jenifer Monserrat, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Jenifer Monserrat Langarica López

• Medina, Ramon, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Ramon Medina, MD

• Alcantar Vallin, Maria de la Luz, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Maria de la Luz Alcantar Vallin, MD

• Padilla Armas, Jorge Luis, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Jorge Luis Padilla Armas

• Oseguera Gonzalez, Alexa Nicole, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

Alexa Nicole Oseguera Gonzalez, MD

• Murguía Soto, César, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

César Murguía Soto, MD

Introduction

Post-infectious glomerulonephritis (PIGN) is a disease with nephritic syndrome with decreased complement usually secondary to an infection of the skin or throat by beta-hemolytic streptococcus, histopathologically with endocapillary proliferation, C3 deposits at the level of the capillary and mesangial wall, IgG-positive IF and subepithelial immune complex deposits.

Case Description

A 22-year-old woman, with type 1 diabetes mellitus for 12 years, with a pregnancy of 38 weeks gestation, presented an infection of the site of cesarean section infection at 3 weeks, with previous treatment with clindamycin and cephalotin. Blood cultures with S. epidermidis and acute kidney injury KDIGO 3 (Cr 5.1mg/dl), hematuria (80% acanthocytes), proteinuria (580mg/day) and hypertension. Complement 15 mg/dL (normal 79 – 152) and normal C4, ANAs, ANCAs, HIV-HCV-HBV negative, albumin 2.78 g/dl., Procalcitonin 5 ng/ml (<0.5 ng/ml), requiring vasopressor amines, hemodialysis, and antibiotic therapy was escalated to meropenem.
Renal biopsy: Postinfectious glomerulonephritis (23 glomeruli with cell crescents, pattern with extracapillary proliferation, mesangial proliferation, endocapillary hypercellularity, double contours. IF: IgG (+++), C3 (++), diffuse granular pattern). At one month with a 50% decrease in proteinuria, normal complement, no hematuria, Cr.s 1.9mg/dl, no hemodialysis required.

Discussion

Treatment is based on treating the infection with antibiotics and the current evidence in RCTs shows no benefit from steroid use, however no persistently low C3 rule out C3 glomerulopathy