C3-Dominant Infection Related Crescentic Glomerulonephritis

Area of Science:

• Nephrology
• Immunology
• Infectious Diseases

Background:

• Infection-related glomerulonephritis (IRGN) and C3 glomerulonephritis (C3GN) are rare in adults.
• A clinical and morphological overlap between IRGN and C3GN is recognized.
• Distinguishing between these conditions can be challenging.

Observation:

• A 59-year-old male with a history of treated HIV, hepatitis B, syphilis, and non-Hodgkin lymphoma presented with acute glomerulonephritis.
• Symptoms included a sore throat with elevated ASO titers, preceding rapidly progressive glomerulonephritis requiring dialysis.
• Kidney biopsy revealed diffuse proliferative glomerulonephritis with a crescentic pattern and exclusive C3 staining.

Findings:

• The patient's presentation met criteria for both IRGN and C3GN.
• Exclusive C3 staining on biopsy is a key feature of C3GN.
• Rapidly progressive glomerulonephritis (RPGN) with crescent formation was evident.

Implications:

• This case underscores the diagnostic complexity when IRGN and C3GN overlap.
• It highlights the importance of considering C3GN in adults with RPGN, even with preceding infection.
• Further research may elucidate shared pathogenic mechanisms between these distinct glomerulonephritides.