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Published on: September 7, 2022
[Infectious glomerulonephritis]
1Service de médecine interne, immunologie clinique, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Post-infectious glomerulonephritis (PIGN) is a kidney disease often seen in children after bacterial infections. While typically favorable, it’s now rarer and affects immunocompromised individuals, leading to more frequent kidney damage.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Post-infectious glomerulonephritis (PIGN) is a common glomerular disease linked to bacterial infections.
- Traditionally affecting young children with upper respiratory tract infections, PIGN presents with nephritic syndrome and characteristic renal histology.
- Recent trends show PIGN is now rare in industrialized nations, primarily affecting immunocompromised populations, with increased risk of renal sequelae.
Purpose of the Study:
- To review the epidemiology, pathophysiology, clinical presentation, and management of post-infectious glomerulonephritis.
- To highlight the shift in PIGN demographics towards immunocompromised hosts and its impact on renal prognosis.
- To discuss the underlying mechanisms involving complement pathways in PIGN.
Main Methods:
- Review of existing literature on post-infectious glomerulonephritis.
- Analysis of epidemiological data and clinical case studies.
- Examination of histopathological findings and pathomechanisms, including complement system involvement.
Main Results:
- PIGN typically manifests 15 days post-infection with nephritic syndrome.
- Histology reveals exsudative endocapillary proliferation and subepithelial "hump-shaped" C3 deposits.
- The disease is now infrequent, predominantly seen in immunocompromised patients, leading to poorer outcomes.
Conclusions:
- Post-infectious glomerulonephritis pathogenesis involves immune complexes and complement activation.
- The changing epidemiology of PIGN necessitates a re-evaluation of its clinical significance and management, especially in vulnerable populations.
- Current treatment for PIGN remains symptomatic.
Abstract:
Infectious glomerulonephritis. Post-infectious or infectious glomerulonephritis (PIGN) represent the most frequent glomerular disease during bacterial infection. Patients, usually young children, with PIGN typically present nephritic syndrome 15 days after an upper respiratory tract infection. In this case renal histology shows exsudative endocapillary proliferation with C3-dominant deposits "hump" shaped in the subepithelial compartment. Renal prognosis was typically favorable. However, nowadays, PIGN is rare and represents less than 1% of kidney biopsies in industrialized countries and usually occurs in immunocompromised hosts (such as patients with cancer, alcoholism, diabetes, elderly patients). Therefore, renal sequels are more frequent. The physiopathology typically involves immune complexes activating the classical complement pathway although alternative complement pathway regulation or abnormal activation were more recently reported. Treatment remains symptomatic.
