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Glomerulonephritis Associated with Nonstreptococcal Infection

Practice Essentials

Postinfectious glomerulonephritis (PIGN) may occur in association with bacterial, viral, fungal, protozoal, and helminthic infections. The classic association of glomerulonephritis (GN) with infection is poststreptococcal GN, usually developing after streptococcal pharyngitis (see Poststreptococcal Glomerulonephritis).
However, in recent decades the spectrum of postinfectious GN has changed. The incidence of poststreptococcal GN, particularly in its epidemic form, has progressively declined in industrialized countries with early use of effective antibiotics.
 

Glomerulonephritis associated with methicillin-resistant Staphylococcus aureus (MRSA) infection has become recognized as a more severe manifestation, which is 3 times more common in older patients in developed countries.
 The majority of patients have diabetes mellitus and present with acute kidney injury, hematuria, and heavy proteinuria. Comorbid diabetes is a predictor of poor outcome; in one series 65% of adults and 55% of older patients with diabetes developed end-stage renal disease (ESRD) after PIGN.
 

Viral-induced GN manifests in significantly different histologic forms of glomerular injury, depending on the duration of viral activity. For example, a patient with a recent self-limited acute varicella-zoster infection may develop diffuse proliferative glomerulonephritis (DPGN), wherease a subacute Epstein-Barr infection lasting weeks or months may result in collapsing focal segmental glomerulosclerosis (cFSGS) or membranous glomerulopathy (MN). Chronic persistent infections—such as with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV)—result in a wide spectrum of glomerular disorders.
 

Glomerular diseases have been reported in association with COVID-19. Cases have included antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, anti-glomerular basement membrane (GBM) disease, pauci-immune crescentic glomerulonephritis, and acute necrotizing GN.

A relationship of GN with occult viral disease has also been reported. Occult HCV infection has been detected in 30%–50% of patients with idiopathic membranous nephropathy, IgA nephropathy, FSGS, antineutrophil cytoplasmic antibody (ANCA)–positive vasculitis, and membranoproliferative GN (MPGN). Occult HBV infection has been described in selected cases of idiopathic membranous nephropathy and IgA nephropathy. There is anecdotal evidence that antiviral therapy has been effective in cases of occult HCV- or HBV-associated GN initially diagnosed idiopathic glomerular disease.
 

The incidence of glomerulonephritis in malaria is estimated to be around 18%
 and in schistosomaisis, approximately 15%.

For patient education information, see Hepatitis BHepatitis C, and Blood in the Urine as well as the Infections Center and Digestive Disorders Center.

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