Reversible renal failure due to IgA nephropathy associated with osteomyelitis

Clinical features of acute glomerulonephritis, with microscopic hematuria, red blood cell (RBC) casts, proteinuria, and acute renal insufficiency developed in a patient with chronic osteomyelitis. Before the development of osteomyelitis, renal function and findings on urinalysis were normal. Complete eradication of osteomyelitis by surgical amputation led to resolution of the abnormal urinary findings, and renal function returned to near pre-osteomyelitis levels. Although acute glomerular disease has been reported to occur as a rare complication of osteomyelitis, the unique feature of the present case was the histological finding of IgA nephropathy. There was no arthritis, purpura, skin rash, or gastrointestinal involvement to suggest a diagnosis of Henoch-Schönlein purpura and there was no evidence of chronic liver disease. The temporal relationship between the onset of the renal disease, which followed the development of chronic osteomyelitis, and its resolution following removal of the focus of infection, suggests that the IgA nephropathy may have been related directly to the osteomyelitis (secondary IgA nephropathy). Glomerular diseases associated with chronic bacterial infections, including osteomyelitis, are discussed, with emphasis on infections that have been associated with the development or exacerbation of IgA nephropathy.