Postinfectious glomerulonephritis in the elderly.
Postinfectious glomerulonephritis (PIGN) is primarily a childhood disease that occurs after an upper respiratory tract infection or impetigo; its occurrence in older patients is not well characterized. Here, we report 109 cases of PIGN in patients ≥65 years old diagnosed by renal biopsy. The male to female ratio was 2.8:1. An immunocompromised background was present in 61%, most commonly diabetes or malignancy. The most common site of infection was skin, followed by pneumonia and urinary tract infection. The most common causative agent was staphylococcus (46%) followed by streptococcus (16%) and unusual gram-negative organisms. Hypocomplementemia was present in 72%. The mean peak serum creatinine was 5.1 mg/dl, and 46% of patients required acute dialysis. The most common light microscopic patterns were diffuse (53%), focal (28%), and mesangial (13%) proliferative glomerulonephritis. IgA-dominant PIGN occurred in 17%. Of the 72 patients with ≥3 months of follow-up (mean, 29 months), 22% achieved complete recovery, 44% had persistent renal dysfunction, and 33% progressed to ESRD. The presence of diabetes, higher creatinine at biopsy, dialysis at presentation, the presence of diabetic glomerulosclerosis, and greater tubular atrophy and interstitial fibrosis predicted ESRD. In summary, the epidemiology of PIGN is shifting as the population ages. Older men and patients with diabetes or malignancy are particularly at risk, and the sites of infection and causative organisms differ from the typical childhood disease. Prognosis for these older patients is poor, with fewer than 25% recovering full renal function.
Mayo Clinic, Division of Anatomic Pathology, Hilton 10-20, 200 First Street, SW, Rochester, MN 55905, USA. nasr.samih@mayo.edu
Samih H
SH
Nasr
Mary E
ME
Fidler
Anthony M
AM
Valeri
Lynn D
LD
Cornell
Sanjeev
S
Sethi
Amy
A
Zoller
Michael B
MB
Stokes
Glen S
GS
Markowitz
Vivette D
VD
D'Agati
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012871:Skin Diseases / Q000150:complications* / Q000382:microbiology; D014552:Urinary Tract Infections / Q000150:complications* / Q000382:microbiology