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Methicillin-resistant Staphylococcus aureus-related glomerulonephritis in a child

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Abstract

Background

Methicillin-resistant Staphylococcus aureus-associated glomerulonephritis (MRSA-GN), a syndrome in which superantigens play an important role in the pathogenesis of the infection, has been well described in adult patients but not previously recognized in children.

Case Diagnosis/Treatment

We report the case of a 6-year-old girl with MRSA-GN. She presented multiple malformations, including tracheal stenosis necessitating tracheotomy. She was admitted to our hospital because of acute pneumonia caused by a MRSA infection and was found to have proteinuria and abnormal renal function. MRSA was detected in her sputum, and this MRSA isolate produced toxic shock syndrome toxin-1, which acts as a superantigen and stimulates Vβ2+ T cells. A blood test revealed that the number of circulating Vβ2+ T cells expressing CD45RO, a marker of activation, was increased along with a concomitant elevation in the levels of serum immunoglobulins. Both are hallmarks of MRSA-GN. The eradication of MRSA using appropriate antibiotics resulted in the disappearance of the proteinuria; in contrast, corticosteroid treatment failed. To the best of our knowledge, this is the youngest patient to be diagnosed with MRSA-GN.

Conclusions

In summary, there should be a high index of suspicion for MRSA-GN, even in the very young, in order to avoid the unnecessary use of immune suppressants in this context.

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References

  1. Haffner D, Schindera F, Aschoff A, Matthias S, Waldherr R, Schärer K (1997) The clinical spectrum of shunt nephritis. Nephrol Dial Transplant 12:1143–1148

    Article  PubMed  CAS  Google Scholar 

  2. Griffin MD, Björnsson J, Erickson SB (1997) Diffuse proliferative glomerulonephritis and acute renal failure associated with acute staphylococcal osteomyelitis. Am Soc Nephrol 8:1633–1639

    CAS  Google Scholar 

  3. Koyama A, Kobayashi M, Yamaguchi N, Yamagata K, Takano K, Nakajima M, Irie F, Goto M, Igarashi M, Iitsuka T, Aoki Y, Sakurai H, Sakurayama N, Fukao K (1995) Glomerulonephritis associated with MRSA infection: a possible role of bacterial superantigen. Kidney Int 47:207–216

    Article  PubMed  CAS  Google Scholar 

  4. Kai H, Shimizu Y, Hagiwara M, Yoh K, Hirayama K, Yamagata K, Ohba S, Nagata M, Koyama A (2006) Post-MRSA infection glomerulonephritis with marked Staphylococcus aureus cell envelope antigen deposition in glomeruli. J Nephrol 19:215–219

    PubMed  CAS  Google Scholar 

  5. Kobayashi M, Koyama A (1999) Methicillin-resistant Staphylococcus aureus-related glomerulonephritis. Nephrol Dial Taransplant 14:17–18

    Article  Google Scholar 

  6. Yoh K, Kobayashi M, Hirayama A, Hirayama K, Yamaguchi N, Nagase S, Koyama A (1997) A case of superantigen-related glomerulonephritis after methicillin-resistant Staphylococcus aureus (MRSA) infection. Clin Nephrol 48:311–316

    PubMed  CAS  Google Scholar 

  7. Barnadas MA, Gelpí C, Rocamora V, Baró E, Ballarín J, Nadal C, Bielsa A, Aróstegui J, Alomar A (1998) Bullous pemphigoid associated with acute glomerulonephritis. Br J Dermatol 138:867–871

    Article  PubMed  CAS  Google Scholar 

  8. Yamashita Y, Tanase T, Terada Y, Tamura H, Akiba T, Inoue H, Ida T, Sasaki S, Marumo F, Nakamoto Y (2001) Glomerulonephritis after methicillin-resistant Staphylococcus aureus infection resulting in end-stage renal failure. Intern Med 40:424–427

    Article  PubMed  CAS  Google Scholar 

  9. Nagaba Y, Hiki Y, Aoyama T, Sano T, Matsuo T, Shimizu T, Tateno S, Sakamoto H, Kamata K, Shigematsu H, Higashihara M, Kobayashi Y (2002) Effective antibiotic treatment of methicillin-resistant Staphylococcus aureus-associated glomerulonephritis. Nephron 92:297–303

    Article  PubMed  CAS  Google Scholar 

  10. Satoskar AA, Nadasdy G, Plaza JA, Sedmak D, Shidham G, Hebert L, Nadasdy T (2006) Staphylococcus infection-associated glomerulonephritis mimicking IgA nephropathy. Clin J Am Soc Nephrol 1:1179–1186

    Article  PubMed  Google Scholar 

  11. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590

    PubMed  CAS  Google Scholar 

  12. Takahashi N, Kato H, Imanishi K, Ohki T, Uehara R, Momoi MY, Nishida H, Uchiyama T (2009) Change of specific T cells in an emerging neonatal infectious disease induced by a bacterial superantigen. Microbiol Immunol 53:524–530

    Article  PubMed  CAS  Google Scholar 

  13. Okuyama S, Wakui H, Maki N, Kuroki J, Nishinari T, Asakura K, Komatsuda A, Sawada K (2008) Successful treatment of post-MRSA infection glomerulonephritis with steroid therapy. Clin Nephrol 70:344–347

    PubMed  CAS  Google Scholar 

  14. Schlievert PM (1993) Role of superantigens in human disease. J Infect Dis 167:997–1002

    Article  PubMed  CAS  Google Scholar 

  15. Chen YR, Wen YK (2011) Favorable outcome of crescentic IgA nephropathy associated with methicillin-resistant Staphylococcus aureus infection. Ren Fail 33:96–100

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was partly supported by the Mami Mizutani Foundation.

Disclosure

All of the authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Pediatrics, Kansai Medical University, 2-3-1 Shin-machi, Hirakata-shi, Osaka, 573-1191, Japan

    Takahisa Kimata, Shoji Tsuji, Ken Yoshimura & Kazunari Kaneko

  2. 2nd Department of Internal Medicine, Kansai Medical University, 2-3-1 Shin-machi, Hirakata-shi, Osaka, 573-1191, Japan

    Hiroyasu Tsukaguchi

Authors
  1. Takahisa Kimata
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  2. Shoji Tsuji
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  3. Ken Yoshimura
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  4. Hiroyasu Tsukaguchi
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  5. Kazunari Kaneko
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Corresponding author

Correspondence to Kazunari Kaneko.

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Kimata, T., Tsuji, S., Yoshimura, K. et al. Methicillin-resistant Staphylococcus aureus-related glomerulonephritis in a child. Pediatr Nephrol 27, 2149–2152 (2012). https://doi.org/10.1007/s00467-012-2229-2

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  • DOI: https://doi.org/10.1007/s00467-012-2229-2

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