A case of IgA‒dominant infection‒related glomerulonephritis (IgA‒IRGN) associated with osteomyelitis in which it was possible to discontinue hemodialysis

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  • Hoshino Kento
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Fukunaga Tsugumi
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Ueki Ai
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Kobayashi Yota
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Tsugawa Shun
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Naito Arisa
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Nishimura Yoshito
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Kuwata Ayako
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Hoshi Takafumi
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Umetani Jun
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Miyake Yuka
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Imakiire Toshihiko
    Department of Nephrology and Endocrinology, National Defense Medical College
  • Oshima Naoki
    Department of Nephrology and Endocrinology, National Defense Medical College

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Other Title
  • 骨髄炎に合併したIgA優位沈着性感染関連糸球体腎炎（IgA-IRGN）において血液透析を離脱し得た1例
  • コツズイエン ニ ガッペイ シタ IgA ユウイ チンチャク セイカンゾメ カンレン シキュウタイジンエン(IgA-IRGN)ニ オイテ ケツエキ トウセキ オ リダツ シエタ 1レイ

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Abstract

<p>A 54‒year‒old male visited a hospital with lower back pain in August 2019 and was hospitalized with a diagnosis of osteomyelitis due to gangrene in the amputation stump of his left toe. He was transferred to our hospital on the 10th hospital day because the gangrene worsened, and his left lower thigh was amputated. Serratia marcescens was cultured from his wound. He presented with nephrotic syndrome involving renal dysfunction, hematuria, hypocomplementemia, and a high anti‒streptolysin O antibody titer. A histological examination of a renal biopsy showed endocapillary proliferative glomerulonephritis, and immunofluorescence analysis revealed that the glomeruli were predominantly IgA‒positive. Therefore, we diagnosed IgA‒dominant infection‒related glomerulonephritis (IgA‒IRGN). Hemodialysis was started on the 39th hospital day, when symptoms of uremia were observed, and vancomycin and ceftriaxone were administered for persistent vertebral osteomyelitis, which was revealed by computed tomography performed on admission. Hemodialysis was discontinued on the 61st hospital day because the patient’s renal function gradually improved. After the hemodialysis was discontinued, no deterioration of his renal function was observed, and he was discharged on the 133rd hospital day. Steroids have not been shown to be effective against IgA‒IRGN, and it is important to select appropriate antibiotics if such infections persist.</p>

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