Abstract
A histological subtype of acute postinfectious glomerulonephritis (APIGN), the garland pattern, is identified not only by characteristic histological findings, but also by severe clinical course as compared with typical APIGN. However, since the morbidity of APIGN has decreased globally, there have been few reports on this disease form in developed countries during the last two decades. Herein, we report a case of adolescent garland-pattern APIGN with IgA-dominant deposits, presenting with severe nephrotic syndrome and protracted hematuria and proteinuria. We also review the clinical and histological features of 13 previously reported cases in Japan and compare them with our present case. In our review, we confirmed IgA deposition in at least three of these patients, in whom urinary protein excretion tended to be greater than those patients without IgA. Greater awareness of this condition is necessary to ensure appropriate follow-up of the clinical course of patients with garland-pattern APIGN with IgA deposition.
References
Berríos X, Lagomarsino E, Solar E, Sandoval G, Guzmán B, Riedel I. Post-streptococcal acute glomerulonephritis in Chile—20 years of experience. Pediatr Nephrol. 2004;19:306–12.
Sarkissian A, Papazian M, Azatian G, Arikiants N, Babloyan A, Leumann E. An epidemic of acute postinfectious glomerulonephritis in Armenia. Arch Dis Child. 1997;77:342–4.
Sorger K, Gessler U, Hübner FK, Köhler H, Schulz W, Stühlinger W, et al. Subtypes of acute postinfectious glomerulonephritis. Synopsis of clinical and pathological features. Clin Nephrol. 1982;17:114–28.
Nasr SH, Markowitz GS, Stokes MB, Said SM, Valeri AM, D’Agati VD. Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature. Medicine (Baltimore). 2008;87:21–32.
Sorger K, Gessler M, Hübner FK, Köhler H, Olbing H, Schulz W, et al. Follow-up studies of three subtypes of acute postinfectious glomerulonephritis ascertained by renal biopsy. Clin Nephrol. 1987;27:111–24.
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5:685–94.
Rodriguez-Iturbe B, Musser JM. The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol. 2008;19:1855–64.
Koo TY, Kim GH, Park H. Clinicopathologic features of IgA-dominant postinfectious glomerulonephritis. Korean J Pathol. 2012;46:105–14.
Nasr SH, Markowitz GS, Whelan JD, Albanese JJ, Rosen RM, Fein DA, et al. IgA-dominant acute poststaphylococcal glomerulonephritis complicating diabetic nephropathy. Hum Pathol. 2003;34:1235–41.
Hashimoto A, Yamada K, Kaga T, Shimizu A, Matsuda A, Shizuku J, et al. Three adult cases of severe acute glomerulonephritis with acute renal failure requiring hemodialysis. Nihon Jinzo Gakkai Shi. 2009;51:884–90.
Kanjanabuch T, Kittikowit W, Eiam-Ong S. An update on acute postinfectious glomerulonephritis worldwide. Nat Rev Nephrol. 2009;5:259–69.
Montseny JJ, Meyrier A, Kleinknecht D, Callard P. The current spectrum of infectious glomerulonephritis. Experience with 76 patients and review of the literature. Medicine (Baltimore). 1995;74:63–73.
Moroni G, Pozzi C, Quaglini S, Segagni S, Banfi G, Baroli A, et al. Long-term prognosis of diffuse proliferative glomerulonephritis associated with infection in adults. Nephrol Dial Transplant. 2002;17:1204–11.
Nasr SH, Fidler ME, Valeri AM, Cornell LD, Sethi S, Zoller A, et al. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol. 2011;22:187–95.
Roy S 3rd, Murphy WM, Arant BS Jr. Poststreptococcal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care. J Pediatr. 1981;98:403–10.
Jovanović D, Kovacević Z, Rabrenović V, Skatarić V. Acute post-streptococcal glomerulonephritis in adults—corticosteroid therapy, yes or no? Vojnosanit Pregl. 2001;58:161–6.
Niimi K, Ide K, Tsuru N. Five cases of acute poststreptococcal glomerulonephritis with acute renal failure and nephrotic syndrome. Nihon Jinzo Gakkai Shi. 2002;44:29–33.
Raff A, Hebert T, Pullman J, Coco M. Crescentic post-streptococcal glomerulonephritis with nephrotic syndrome in the adult: is aggressive therapy warranted? Clin Nephrol. 2005;63:375–80.
Suyama K, Kawasaki Y, Suzuki H. Girl with garland-pattern poststreptococcal acute glomerulonephritis presenting with renal failure and nephrotic syndrome. Pediatr Int. 2007;49:115–7.
Haas M, Racusen LC, Bagnasco SM. IgA-dominant postinfectious glomerulonephritis: a report of 13 cases with common ultrastructural features. Hum Pathol. 2008;39:1309–16.
Worawichawong S, Girard L, Trpkov K, Gough JC, Gregson DB, Benediktsson H. Immunoglobulin A-dominant postinfectious glomerulonephritis: frequent occurrence in nondiabetic patients with Staphylococcus aureus infection. Hum Pathol. 2011;42:279–84.
Srisawat N, Aroonpoonsub L, Lewsuwan S, Kanjanabuch T, Avihingsanon Y, Praditpornsilpa K, et al. The clinicopathology and outcome of post-infectious glomerulonephritis: experience in 36 adults. J Med Assoc Thai. 2006;89(Suppl 2):S157–62.
Luo YH, Kuo CF, Huang KJ, Wu JJ, Lei HY, Lin MT, et al. Streptococcal pyrogenic exotoxin B antibodies in a mouse model of glomerulonephritis. Kidney Int. 2007;72:716–24.
Yoshizawa N, Yamakami K, Fujino M, Oda T, Tamura K, Matsumoto K, et al. Nephritis-associated plasmin receptor and acute poststreptococcal glomerulonephritis: characterization of the antigen and associated immune response. J Am Soc Nephrol. 2004;15:1785–93.
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Kanno, M., Tanaka, K., Kimura, H. et al. Garland-pattern postinfectious glomerulonephritis with IgA-dominant deposition. CEN Case Rep 3, 56–62 (2014). https://doi.org/10.1007/s13730-013-0086-x
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DOI: https://doi.org/10.1007/s13730-013-0086-x