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Postinfectious Glomerulonephritis with Crescents in an Elderly Diabetic Patient after Acute Gastroenteritis: Case

Satyanand Sathi1, Anil Kumar Garg1, Ajay Kumar Singh2

  • 1Department of Medicine, S.M.M.H. Medical College Saharanpur, Saharanpur, India.

Case Reports in Nephrology and Dialysis
|June 14, 2019
PubMed

Insights

Postinfectious glomerulonephritis (PIGN) can affect adults, especially the elderly and immunocompromised. Early steroid treatment may improve outcomes in atypical PIGN cases, avoiding dialysis.

Area of Science:

  • Nephrology
  • Immunology
  • Pathology

Background:

  • Postinfectious glomerulonephritis (PIGN) is typically a childhood illness following infections.
  • In adults, PIGN is more prevalent in immunocompromised individuals, including diabetics and alcoholics.
  • Staphylococcus is a common cause in the elderly, contrasting with Streptococcus in younger populations.

Observation:

  • An elderly diabetic male presented with severe acute kidney injury and active urinary sediment post-gastroenteritis.
  • Laboratory results showed significantly low serum C3 and normal serum C4 levels.
  • Renal biopsy revealed diffuse proliferative glomerulonephritis with crescents and characteristic immunofluorescence and electron microscopy findings.

Findings:

  • The patient exhibited a severe presentation of PIGN, atypical for his demographic.
  • Despite controversial treatment guidelines, the patient showed a remarkable response to steroid therapy.
  • Steroid treatment led to recovery, obviating the need for hemodialysis within two weeks.

Implications:

  • This case highlights the importance of considering atypical PIGN presentations in the elderly.
  • Prompt diagnosis and management, including steroid therapy, can lead to favorable outcomes in adult PIGN.
  • Awareness of PIGN in immunocompromised adults, particularly diabetics, is crucial for timely intervention.

Keywords:
Acute gastroenteritisCrescentsElderly diabeticPostinfectious glomerulonephritis

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