Infection-related glomerulonephritis: changing demographics and outcomes

Postinfectious glomerulonephritis (PIGN) is the classic form of immune-mediated infection-associated glomerulonephritis following a nonrenal infection. Its epidemiology has been changing over the past several decades, with recent data indicating a global decline, particularly in developed countries. This is owing to better and earlier treatment of infections, and improvements in living conditions and nutrition. The currently affected patient population tends to be older, with more adults developing the disease, especially those with comorbidities such as diabetes; approximately one-third of adults with PIGN will have at least one comorbid factor. Organisms causing PIGN are also changing, with fewer cases associated with Streptococcus and more cases owing to Staphylococcus. IgA-dominant PIGN has become more widely recognized as a lesion usually found in adult patients with diabetes or another form of chronic illness, with more severe clinical manifestations and a more guarded outcome. Children have the best prognosis and outcome followed by healthy adults, with adults having comorbid factors exhibiting more chronic renal injury following PIGN. It is important to be aware of these shifting features of PIGN, as the impacted patient population is at higher risk for poor renal outcome.