The management of bacterial infection-associated glomerulonephritis

Abstract

Bacterial infection-associated immune complex glomerulonephritis (GN) has been a known entity for several centuries. Bacterial infection-associated GN may occur after the infection has resolved (post-infectious GN) or during the course of an active, usually subacute or chronic infection (GN associated with active infection). The most well-known and most completely characterized form of bacterial infection-associated GN is post-streptococcal GN. Post-streptococcal GN is the hallmark example of post-infectious GN and traditionally occurs several weeks after an infection with group A, β-hemolytic streptococcus species has resolved. Post-streptococcal GN usually carries an excellent prognosis. However, over the past several decades there has been a significant decline in the incidence of post-streptococcal GN and an emergence of GN associated with active infection and in particular staphylococcal-associated GN. There are many differences between post-streptococcal GN and staphylococcal-associated GN including differences in clinical presentation, histopathology, and prognosis. These differences affect how these conditions are diagnosed and treated. Specifically, immunosuppression should be avoided in patients with a GN that occurs during an active infection but can be considered in patients with severe post-infectious GN. In this chapter, we review the available evidence for the management of both post-streptococcal GN and staphylococcal-associated GN. Through these examples, we highlight important differences regarding the clinical presentation, diagnosis, and management of post-infectious GN and the GN associated with active infection. Finally, the potential confounder of antibiotic-associated nephrotoxicity is considered and how this form of acute kidney injury can be differentiated from an infection-associated GN is discussed.