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IgA-dominant infection-related glomerulonephritis with NAPlr-positive tubulointerstitial nephritis

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Abstract

Infection-related glomerulonephritis (IRGN) is one of the most common causes of acute kidney injury (AKI). Positive glomerular staining of the nephritis-associated plasmin receptor (NAPlr) has been reported as a useful biomarker of IRGN. Although the infection can provoke acute tubulointerstitial nephritis (AIN), there are few reports of positive staining for NAPlr with AIN. We report a case of methicillin-sensitive Staphylococcus aureus (MSSA) infection-related nephritis complicated with AIN, which showed positive staining for tubulointerstitial NAPlr. The patient developed AKI and nephrotic syndrome during an intraperitoneal MSSA infection. A diagnosis of IRGN complicated by infection-related acute tubulointerstitial nephritis (IRAIN) was made based on glomerular endocapillary proliferation with tubulointerstitial infiltrating cells and tubular atrophy. Tubulointerstitial infiltrating cells were positive for NAPlr staining and plasmin activity. Treatment of the infection by antibiotics and drainage did not improve the AKI, but steroid administration improved that. NAPlr evaluation is a helpful tool for identifying causes of AIN during infection.

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Acknowledgements

We thank Lee Chiwei, Masayoshi Ishii, Ohyama Etsuko, Omote Daichi, and Naoki Hashimoto for helpful discussions regarding our patient’s treatment.

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Authors and Affiliations

  1. Department of Nephrology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan

    Issei Okunaga, Shin-ichi Makino, Daisuke Honda, Narihito Tatsumoto, Masashi Aizawa & Katsuhiko Asanuma

  2. Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, 193-0998, Tokyo, Japan

    Takashi Oda

Authors
  1. Issei Okunaga
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  2. Shin-ichi Makino
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  3. Daisuke Honda
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  4. Narihito Tatsumoto
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  5. Masashi Aizawa
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  6. Takashi Oda
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  7. Katsuhiko Asanuma
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Correspondence to Katsuhiko Asanuma.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number1178(899)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This case report is conducted in compliance with the bioethical rules of Chiba University Hospital. This study has been approved by the Bioethics Review Committee of Chiba University.

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Written informed consent for treatment and for publication of this report was obtained from the patient.

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Okunaga, I., Makino, Si., Honda, D. et al. IgA-dominant infection-related glomerulonephritis with NAPlr-positive tubulointerstitial nephritis. CEN Case Rep 12, 402–407 (2023). https://doi.org/10.1007/s13730-023-00782-x

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  • DOI: https://doi.org/10.1007/s13730-023-00782-x

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