Bacterial infection-related glomerulonephritis in adults

Nasr et al.

Infection-related glomerulonephritis occurring in patient with
 diabetic glomerulosclerosis. Mesangial nodules due to
diabetes are seen.

Acute poststreptococal glomerulonephritis (PSGN) is common in children. In the past 3 decades, the number of adults with infection-related glomerulonephritis (IRGN) has been increased. IRGN in adults has a number of differences from PSGN in children:

• Adults with IRGN usually have concurrent bacterial infection while children with PSGN, as the name implies, have renal disease after the infection subsided. Immunosuppressants are not recommended in the former group.
• IRGN are usually caused by non-streptococcal bacteria
• A large percentage of adults with IRGN are immunocompromised, especially diabetics and elderlies. These patients had poor disease outcome.
• Both adults with IRGN and children with PSGN present with acute nephritis, but elderly patients with IRGN have more severe complication such as heart failure, acute renal failure requiring dialysis, than children or younger adults. This most likely reflects more chronic condition such as diabetes, atherosclerosis in elderlies.

Traditionally, the pathogenesis model of PSGN is deposition of circulating immune complex to the glomerular capillary walls. Newer evidence points to the in situ immune complex formation and molecular mimicry. Host factor has been indicated. Defect in alternative pathway of complement are recognized in some patients.