title: [Successful treatment of MRSA-associated glomerulonephritis with antibiotic therapy].
abstract: We report a case of methicillin-resistant Staphylococcus aureus (MRSA)-associated glomerulonephritis treated with antibiotic therapy. A 67-year-old man was admitted to our hospital because of proteinuria, hematuria, purpura, and high fever one month after a graft replacement of an abdominal aortic aneurysm. MRSA was detected in specimens of his blood, sputum, and joint fluid. Before his operation, he had shown no renal abnormalities. He presented with a rapid deterioration of renal function following MRSA infection. Maximum level of proteinuria was 1.5 g/day, serum creatinine (Cr) was 3.5 mg/dl, and blood urea nitrogen was 57 mg/dl. Renal biopsy revealed necrotizing crescentic glomerulonephritis. Immunofluorescence examination showed IgA and C3 deposits. Clinical and pathological examinations showed the typical features of MRSA-associated glomerulonephritis. Vancomycin and fosfomycin were administered intravenously. The serum level of C-reactive protein fell from 22.0 mg/dl to 0.1 mg/dl. Proteinuria also decreased and the patient's renal function improved in parallel with the decreased activity of MRSA infection. After three months of antibiotic treatment, proteinuria was negative and the level of serum Cr had dropped to 0.9 mg/dl. These findings suggest that antibiotic treatment can lead to complete remission of MRSA-associated glomerulonephritis.
authors.affiliation: Department of Internal Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagaba
authors.forename: Togo
authors.initials: T
authors.lastname: Aoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Sano
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Matsuo
authors.forename: Rika
authors.initials: R
authors.lastname: Moriya
authors.forename: Hisato
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Kouju
authors.initials: K
authors.lastname: Kamata
authors.forename: Masaaki
authors.initials: M
authors.lastname: Higashihara
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005578:Fosfomycin / Q000627:therapeutic use*; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D011183:Postoperative Complications; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D014640:Vancomycin