title: Fever and prodromal infections in anti-glomerular basement membrane disease.
abstract: OBJECTIVE
  Anti-glomerular basement membrane (GBM) disease is an autoimmune disorder with rapidly progressive glomerulonephritis and alveolar haemorrhage. Fever symptoms and prodromal infections have been reported in many cases, but still not been elucidated.
  
  
  METHODS
  Our study enrolled 140 consecutive patients with anti-GBM disease and retrospectively analyzed the characteristics of fever symptoms and the possible reasons.
  
  
  RESULTS
  Among the 140 patients, 94 (67.1%) patients presented with fever (over 37.5°C) prior to admission or within 48 h of hospitalization. Among those with fever, 74 (78.7%) patients had infections, 15 (16.0%) patients had positive serum anti-neutrophil cytoplasmic antibodies, all towards myeloperoxidase, which was comparable to the patients without fever (17.4%, P = 0.830). There were 93/140 patients suffered from infections, with 47.3% in lungs and 31.2% on upper respiratory tract. In some cases, we identified the microbes of infections, including Candida albicans, Escherichia coli, Acinetobacter baumannii, Enterococcus faecalis, Klebsiella pneumoniae, Hemolytic staphylococci, Pseudomonas aeruginosa and Citrobacter braakii. Patients with fever had higher levels of serum anti-GBM antibodies (154.9 ± 58.4 vs. 106.0 ± 63.2 IU/mL, P < 0.001), higher serum creatinine (733.4 ± 402.5 vs. 580.6 ± 368.1 μmol/L, P = 0.032), higher percentage of crescents (87.0 ± 15.6 vs. 67.4 ± 37.6%, P = 0.021), and higher frequency of progression to end stage renal disease (ESRD) (80.9% vs. 60.9%, P = 0.011).
  
  
  CONCLUSIONS
  We concluded that fever is a common symptom in anti-GBM disease and associates with more severe glomerulonephritis. The majority of patients at presentation had fever with respiratory tract infections, which needs further investigation to reveal their role in the pathogenesis of anti-GBM disease.
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
authors.forename: Qiu-Hua
authors.initials: QH
authors.lastname: Gu
authors.affiliation: Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Xie
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Jia
authors.affiliation: Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Ma
authors.affiliation: Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
authors.forename: Yun-Hua
authors.initials: YH
authors.lastname: Liao
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Cui
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.|Peking-Tsinghua Center for Life Sciences, Beijing, China.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Zhao
mesh_terms: D000328:Adult; D019867:Anti-Glomerular Basement Membrane Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D062706:Prodromal Symptoms; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers
keywords: anti-glomerular basement membrane disease; fever; infection; kidney injury; pathogen