Rapid progression to end-stage renal disease in a child with IgA-dominant infection-related glomerulonephritis associate
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CASE REPORT
Rapid progression to end‑stage renal disease in a child with IgA‑dominant infection‑related glomerulonephritis associated with parvovirus B19 Yoko Shirai1 · Kenichiro Miura1 · Tomoo Yabuuchi1 · Takeshi Nagasawa1 · Kiyonobu Ishizuka1 · Kazuhiro Takahashi2 · Sekiko Taneda3 · Kazuho Honda4 · Yutaka Yamaguchi5 · Hitoshi Suzuki6 · Yusuke Suzuki6 · Motoshi Hattori1 Received: 15 February 2020 / Accepted: 25 June 2020 © Japanese Society of Nephrology 2020
Abstract Parvovirus B19 (PVB19) has been known to cause acute glomerulonephritis and nephrotic syndrome with various renal histologic patterns, such as endocapillary glomerulonephritis and collapsing glomerulopathy. Remission is achieved spontaneously or by treatment with steroid and/or immunosuppressants in most patients, except those with sickle cell anemia or two APOL1 risk alleles. In this study, we report the case of a previously healthy 5-year-old boy with infection-related glomerulonephritis (IRGN) associated with PVB19 that progressed to end-stage renal disease (ESRD). He presented with macrohematuria, nephrotic-range proteinuria, and progressive renal dysfunction despite treatment with methylprednisolone pulse therapy, plasmapheresis, and intravenous immunoglobulin. The kidney biopsy specimens exhibited endocapillary infiltration and mesangiolysis with cellular crescent formation. Immunofluorescence analysis revealed that IgA was dominantly positive in the glomeruli, with some co-localized with KM55, which is a specific monoclonal antibody for galactosedeficient IgA1 (Gd-IgA1). The intensity of the KM55 signal in the present patient was weaker than that in patients with IgA nephropathy. To our knowledge, this is the first report of IRGN associated with PVB19 that progressed to ESRD without any underlying diseases. Further investigations are needed to determine the significance of IgA and Gd-IgA1 deposition in IRGN associated with PVB19. Keywords Infection-related glomerulonephritis · Parvovirus B19 · Galactose-deficient IgA1 Abbreviations PVB19 Parvovirus B19 IRGN Infection-related glomerulonephritis ESRD End-stage renal disease * Motoshi Hattori [email protected] 1
Department of Pediatric Nephrology, School of Medicine, Tokyo Women’s Medical University, 8‑1, Kawada‑cho, Shinjuku‑ku, Tokyo 162‑8666, Japan
2
Department of Pediatrics, Teikyo University, 2‑11‑1, Kaga, Itabashi‑ku, Tokyo, Japan
3
Department of Pathology, Tokyo Women’s Medical University, 8‑1, Kawada‑cho, Shinjuku‑ku, Tokyo, Japan
4
Department of Anatomy, School of Medicine, Showa University, 1‑5‑8, Hatanodai, Shinagawa‑ku, Tokyo, Japan
5
Yamaguchi Pathology Laboratory, Matsudo, Japan
6
Department of Nephrology, Faculty of Medicine, Juntendo University, 3‑1‑3, Hongo, Bunkyo‑ku, Tokyo, Japan
Gd-IgA1 Galactose-deficient IgA1 PCR Polymerase chain reaction TLR Toll-like receptor CpG-ODN Cytosine linked to a guanine by a phosphatebound oligodeoxynucleotide
Introduction Parvovirus B19 (PVB19) is the etiological agent of erythema infectiosum, which has been found
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