title: An adult with acute poststreptococcal glomerulonephritis complicated by hemolytic uremic syndrome and nephrotic syndrome.
abstract: We report the case of a 47-year-old man with the simultaneous occurrence of clinical and laboratory features consistent with acute poststreptococcal glomerulonephritis (APSGN), hemolytic uremic syndrome (HUS), and nephrotic syndrome. Acute nephritic syndrome occurred 3 weeks after having pharyngeal pain and diarrhea. He presented with edema and hypertension on admission. Laboratory evaluation showed hemolytic anemia with fragmentation, thrombocytopenia, elevated lactic dehydrogenase level, low haptoglobin level, low complement C3 level, and elevated antistreptolysin-O titer. Serum creatinine level was 1.22 mg/dL (108 micromol/L), and urinalysis showed marked proteinuria, with protein of 8.7 g/d, and hematuria. The renal biopsy specimen was characteristic of APSGN, but not HUS. Moderate expansion of the mesangial matrix, moderate proliferation of epithelial and endothelial cells, and marked infiltration of neutrophils was seen by means of light microscopy, and many subepithelial humps were seen by means of electron microscopy. Neither fibrin deposition nor evidence of thrombotic microangiopathy was found. Complement C3 deposition along the capillary wall and tubules was seen in an immunofluorescence study. The patient was administered plasma infusion at 320 mL/d and antihypertensive drugs. Serum complement C3 and haptoglobin levels returned to normal within 3 weeks. This is a rare case of the simultaneous occurrence of APSGN, HUS, and nephrotic syndrome.
authors.affiliation: Second Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Izumi
authors.forename: Toshitake
authors.initials: T
authors.lastname: Hyodo
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Imakiire
authors.forename: Tatsuyoshi
authors.initials: T
authors.lastname: Ikenoue
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Suzuki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yoshizawa
authors.forename: Soichiro
authors.initials: S
authors.lastname: Miura
mesh_terms: D000208:Acute Disease; D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology; D000942:Antigens, Bacterial / Q000276:immunology; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000276:immunology; D001324:Autoantigens / Q000276:immunology; D001426:Bacterial Proteins / Q000276:immunology / Q000502:physiology; D003176:Complement C3 / Q000032:analysis / Q000172:deficiency; D003404:Creatinine / Q000097:blood; D005921:Glomerulonephritis / Q000209:etiology* / Q000473:pathology; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology*; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000473:pathology; D009439:Neuraminidase / Q000502:physiology; D009504:Neutrophils / Q000473:pathology; D011507:Proteinuria / Q000209:etiology; D013290:Streptococcal Infections / Q000150:complications* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000276:immunology / Q000302:isolation & purification*; D013301:Streptolysins / Q000276:immunology
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D015295:Antigens, Tumor-Associated, Carbohydrate; D001324:Autoantigens; D001426:Bacterial Proteins; D003176:Complement C3; D013301:Streptolysins; C025964:streptolysin O; C016467:Thomsen-Friedenreich antigen; D003404:Creatinine; D009439:Neuraminidase