Infection-Related GN

Today we discussed a case of a gentleman with a recent hospitalization for bacteremia who presented with hypertension, renal failure, nephrotic range proteinuria and dysmorphic RBCs consistent with a glomerulonephritis. We learned the following, pathological-based approach to classifying GNs.

GN

Courtesy: AccessMedicine

Infection-Related GN (IRGN)

  • Classically, IRGN begins 7-10 days after a RTI and 2-4 weeks after a skin infection but more commonly the GN coincides with the infection in adults
  • The presentation involves variable degrees of HTN, edema and AKI with a nephritic sediment (dysmorphic RBCs and RBC casts are highly specific though not sensitive for an acute GN)
  • variable degrees of proteinuria can occur
    • we reviewed that virtually any nephritic syndrome can present with nephrotic range-proteinuria (>3g/day)
  • treatment is supportive in most cases
  • Likelihood of full renal recovery is low, and and in some reports up to 50% of patients progress with ESRD
  • Bottom-line, infection-related kidney injury has a broad differential (sepsis-mediated, hypovolemia, medication-related ATN/AIN, ischemic ATN, AND infection-related GN). Even though IRGN is much, much less common than most of the other etiologies, keep it on the differential

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