Postinfectious glomerulonephritis: Is there a role for steroids?

Abstract

The role of steroids in treatment of postinfectious glomerulonephritis (PIGN) has been controversial. The reason for such controversy is the risk of infection relapse associated with steroid therapy. Steroids may have a place in the treatment of resistant cases where renal function does not improve despite aggressive antibiotic therapy as well as in patients with crescentic form of PIGN. We report a case of a 39 year-old Caucasian man who was diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia resulting in acute IgA dominant PIGN that failed to respond to antibiotic treatment alone, but responded significantly to steroids in addition to antibiotics. This anecdotal experience suggests that steroids could be considered in conjunction with antibiotic therapy for the treatment of refractory cases of PIGN or crescentic form of PIGN. More studies with long-term follow-up of patients treated with steroids in addition to antimicrobial agents are required to quantify the risk of infection relapse with steroid therapy.

Keywords: Methicillin-resistant Staphylococcus aureus; postinfectious glomerulonephritis; steroids.

Figure 1

CT scan of abdomen with contrast showing bilateral psoas abscesses

Figure 2

Serum creatinine time course and antibiotics administered during the hospital stay

Figure 3

(a) Glomerulus with small cellular crescent, fibrinoid necrosis (top) and small hump-shaped deposit (arrow) (Jones’ silver stain, ×400). (b) Immunofluorescence showed 2+ IgA predominantly mesangial and segmental capillary wall staining (anti-IgA IF, ×400). (c) By electron microscopy, rare hump-type subepithelial deposits were seen, protruding out from the basement membrane, in addition to scattered mesangial deposits (transmission electron microscopy, ×10,000)