Staphylococcus-induced glomerulonephritis: potential role for corticosteroids

BMJ Case Rep. 2021 Jan 27;14(1):e237011. doi: 10.1136/bcr-2020-237011.

Abstract

Staphylococcus aureus is a troublesome pathogen, responsible for a broad range of clinical manifestations, ranging from benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis. The kidney can be affected through a rapidly progressive glomerulonephritis mediated by an inflammatory reaction against a superantigen deposited in the glomerulus during the infection's course. This glomerulopathy has a poor prognosis, often leading to chronically impaired kidney function, eventually progressing to end-stage renal disease. Treatment rests on antibiotherapy. Despite the inflammatory role in this disease's pathophysiology, most authors discourage a simultaneous immunosuppressive approach given the concomitant infection. However, there are some reports of success after administration of systemic corticosteroids in these patients. We present a 66-year-old man with a staphylococcus-induced glomerulonephritis brought on by a vascular graft infection, with rapidly deteriorating kidney function despite extraction of the infected graft and 3 weeks of antibiotherapy with achievement of infection control. Kidney function improved after the introduction of corticosteroids. This case highlights the potential role of corticosteroids in selected cases of staphylococcus-induced glomerulonephritis, particularly those in which the infection is under control.

Keywords: acute renal failure; contraindications and precautions; infectious diseases.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / drug therapy*
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / metabolism
  • Acute Kidney Injury / pathology
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Antigen-Antibody Complex / metabolism
  • Blood Culture
  • Blood Vessel Prosthesis*
  • Complement C3 / metabolism
  • Device Removal
  • Disease Progression
  • Drug Tapering
  • Glomerulonephritis / drug therapy*
  • Glomerulonephritis / etiology
  • Glomerulonephritis / metabolism
  • Glomerulonephritis / pathology
  • Glucocorticoids / therapeutic use*
  • Humans
  • Immunoglobulin A / metabolism
  • Male
  • Methylprednisolone / therapeutic use
  • Prednisolone / therapeutic use
  • Prosthesis-Related Infections / complications
  • Prosthesis-Related Infections / drug therapy*
  • Staphylococcal Infections / complications
  • Staphylococcal Infections / drug therapy*
  • Staphylococcus aureus

Substances

  • Anti-Bacterial Agents
  • Antigen-Antibody Complex
  • Complement C3
  • Glucocorticoids
  • Immunoglobulin A
  • Prednisolone
  • Methylprednisolone