American Journal of Kidney Diseases

Staphylococcus-Related Glomerulonephritis and Poststreptococcal Glomerulonephritis: Why Defining “Post” Is Important in Understanding and Treating Infection-Related Glomerulonephritis

Published:April 15, 2015DOI:
      A spate of recent publications describes a newly recognized form of glomerulonephritis associated with active staphylococcal infection. The key kidney biopsy findings, glomerular immunoglobulin A (IgA) deposits dominant or codominant with IgG deposits, resemble those of IgA nephritis. Many authors describe this condition as “postinfectious” and have termed it “poststaphylococcal glomerulonephritis.” However, viewed through the prism of poststreptococcal glomerulonephritis, the prefix “post” in poststaphylococcal glomerulonephritis is historically incorrect, illogical, and misleading with regard to choosing therapy. There are numerous reports describing the use of high-dose steroids to treat poststaphylococcal glomerulonephritis. The decision to use steroid therapy suggests that the treating physician believed that the dominant problem was a postinfectious glomerulonephritis, not the infection itself. Unfortunately, steroid therapy in staphylococcus-related glomerulonephritis can precipitate severe staphylococcal sepsis and even death and provides no observable benefits. Poststreptococcal glomerulonephritis is an authentic postinfectious glomerulonephritis; poststaphylococcal glomerulonephritis is not. Making this distinction is important from the perspective of history, pathogenesis, and clinical management.

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      Linked Article

      • Postinfectious Versus Infection-Related Glomerulonephritis
        American Journal of Kidney DiseasesVol. 66Issue 4
        • Preview
          Glassock et al1 raise interesting issues regarding the concept of infection-related glomerulonephritis (GN). The classical features of postinfectious GN consist of an episode of infection, resolution of the infection, a latency period, then an acute GN. The pathologic picture is one of acute exudative GN, capillary wall immune deposits containing C3 with or without immunoglobulins (IgG, IgA, and IgM), and electron-dense deposits consisting of subepithelial humps (with or without intramembranous, mesangial, and subendothelial deposits).
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        • PDF
      • Expanding the Domain of Postinfectious Glomerulonephritis
        American Journal of Kidney DiseasesVol. 66Issue 4
        • Preview
          The article on infection-related glomerulonephritis (GN) by Glassock et al1 emphasizes the important differences between true “postinfectious GN,” such as poststreptococcal GN, and infection-associated GN, such as the IgA-dominant lesion associated with ongoing staphylococcal infection.
        • Full-Text
        • PDF