4.2 Article

A case of acute poststreptococcal glomerulonephritis complicated by interstitial nephritis related to streptococcal pyrogenic exotoxin B

Journal

PATHOLOGY INTERNATIONAL
Volume 72, Issue 3, Pages 200-206

Publisher

WILEY
DOI: 10.1111/pin.13203

Keywords

nephritis-associated plasmin receptor; poststreptococcal glomerulonephritis; streptococcal pyrogenic exotoxin B; tubulointerstitial nephritis

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This paper presents a case of a patient who developed acute kidney injury and nephrotic syndrome following streptococcal cutaneous infection. The renal biopsy showed C3 deposition in the tubular basement membrane and the presence of nephritogenic antigens and upregulation of plasmin activity in the glomeruli, suggesting a possible role of streptococcal pyrogenic exotoxin B (SpeB) toxicity in poststreptococcal tubulointerstitial nephritis.
This paper presents the case of a patient who developed acute kidney injury and nephrotic syndrome following streptococcal cutaneous infection. He presented with microhematuria, severe proteinuria and systemic edema 5 days after infection. Blood examination showed elevated creatinine level, hypocomplementemia, and elevated anti-streptolysin O level. Renal biopsy revealed endocapillary proliferative glomerulonephritis with tubulointerstitial nephritis (TIN). Immunofluorescence revealed C3-dominant glomerular staining, while electron microscopy showed hump-shaped subepithelial deposits. The patient was therefore diagnosed with poststreptococcal glomerulonephritis. The unique histological feature was C3 deposition in the tubular basement membrane (TBM), in which we detected streptococcal pyrogenic exotoxin B (SpeB), a nephritogenic antigen produced by streptococci. No nephritis-associated plasmin receptor or plasmin activity was evident in the TBM. These nephritogenic antigens and upregulation of plasmin activity were observed in glomeruli. This case suggests that TIN after poststreptococcal infection might be partially attributable to SpeB toxicity.

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