title: Nephrotic Syndrome without Hematuria due to Infection-Related Glomerulonephritis Mimicking Minimal-Change Disease in a Child.
abstract: Nephrotic syndrome without hematuria due to infection-related glomerulonephritis is uncommon. The present report describes a case of nephrotic syndrome due to infection-related glomerulonephritis without hematuria and hypertension in an older child. A 14-year-old boy was referred to our hospital because of a 5-day history of fever, nausea, weight gain and recent leg edema without hypertension. Laboratory data showed nephrotic-range proteinuria, hypoalbuminemia, mild hypocomplementemia and acute renal injury without hematuria. Although, due to the clinical presentation, minimal-change nephrotic syndrome was mostly suspected, a renal biopsy showed endocapillary hypercellularity mainly of mononuclear cells with segmental mesangiolytic changes. Fine granular IgG and C3 deposits were noted by an immunofluorescent study; many relatively small electron-dense deposits were observed electron-microscopically. These findings led to the diagnosis of nephrotic syndrome due to infection-related endocapillary proliferative glomerulonephritis, although the causative organism of his nephritis was not detected. He recovered with rest and dietary cure. When we examine an acute nephrotic child, infection-related glomerulonephritis should be considered as the differential diagnosis to avoid unnecessary use of corticosteroids.
authors.affiliation: Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, Niigata, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Iwafuchi
authors.affiliation: Department of Internal Medicine, Kidney Center, Niigata, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Morioka
authors.affiliation: Department of Pathology, Shinrakuen Hospital, Niigata, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Morita
authors.affiliation: Division of Laboratory Science, Niigata University Graduate School of Health Sciences, Niigata, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, Niigata, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Oyama
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
keywords: Corticosteroids; Endocapillary proliferative glomerulonephritis; Infection-related glomerulonephritis; Minimal-change disease; Nephrotic syndrome