Advertisment

Indian Journal of Nephrology About us |  Subscription |  e-Alerts  | Feedback | Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Current Issue | Archives| Ahead of print | Search |Instructions |  Editorial Board  

Users Online:444

Official publication of the Indian Society of Nephrology
  Search
 
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (550 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
   References
   Article Figures

 Article Access Statistics
    Viewed1526    
    Printed27    
    Emailed0    
    PDF Downloaded74    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO EDITOR
Year : 2013  |  Volume : 23  |  Issue : 3  |  Page : 240-241
 

Proliferative glomerulonephritis causing acute renal failure in a child with Salmonella septicemia


Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India

Date of Web Publication14-May-2013

Correspondence Address:
G S Dhooria
Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.111875

Rights and Permissions



How to cite this article:
Dhooria G S, Bains H S, Bhat D. Proliferative glomerulonephritis causing acute renal failure in a child with Salmonella septicemia. Indian J Nephrol 2013;23:240-1

How to cite this URL:
Dhooria G S, Bains H S, Bhat D. Proliferative glomerulonephritis causing acute renal failure in a child with Salmonella septicemia. Indian J Nephrol [serial online] 2013 [cited 2021 Sep 20];23:240-1. Available from: https://www.indianjnephrol.org/text.asp?2013/23/3/240/111875


Sir,

An 11- year- old male presented with fever since 6 days, hematuria since 4 days, pain in abdomen and oliguria since 3 days. There was no dysuria, frequency or pyoderma in the recent past. Growth and development was normal. On examination, he was sick, febrile and hypertensive (BP 132/98 mm Hg). He had mild pallor, facial puffiness, pedal edema and mild hepatosplenomegaly.

Urine analysis showed 3 + proteinuria, 100-120 RBCs and 8-12 WBCs/hpf and red cell casts. FeNa was < 1 (0.82). The 24-h urine protein was 1.21 g/day (>40 mg/m 2/ 24 hours). Serum creatinine was 7.1 mg/dl with serum albumin 2.7 g/dl and serum cholesterol 156 mg/dl. Ultrasonography abdomen showed bulky kidneys with increased cortical echogenicity and prominent pyramids.

Anti-streptolysin O (ASLO) titers were normal. C3 levels were 84 mg/dl (normal > 90 mg/dLdl). Urine culture showed no growth. Blood culture grew  Salmonella More Details typhi and Widal test was positive ("O" titers 1:160 and "H" titers 1:2560). Other investigations were normal.

In view of oliguric renal failure, the patient was started with hemodialysis and other supportive treatment. He required 2 weeks of hemodialysis. In view of persistent renal dysfunction and normal ASLO titers kidney biopsy was done, which revealed nine enlarged glomeruli showing mild increase in mesangial cellularity, extensive infiltration by neutrophils and no crescents. Tubules, interstitium and blood vessels were unremarkable. Features were suggestive of diffuse proliferative glomerulonephritis [Figure 1]. Immunoflorescence showed no deposits.
Figure 1: Renal biopsy (Light microscopy) showing proliferative glomerulonephritis with increased mesangial cellularity and extensive neutrophilic infiltration in glomeruli

Click here to view


At discharge, the patient had serum creatinine of 1.3 mg/dl and was on one anti-hypertensive agent. Serum creatinine and C3 levels came to normal after 4 weeks. Microscopic hematuria and hypertension took 6 months to resolve, while proteinuria resolved completely after 1 year.

Renal involvement with enteric fever is noticed only in 2-3% of the cases. The common complications of typhoid related to the urinary tract include cystitis, pyelitis, pyelonephritis and mild proteinuria. [1] Different mechanisms can lead to renal involvement in typhoid fever. Dehydration not managed correctly may lead to acute tubular necrosis. Other renal manifestations like Immunoglobulin A (IgA) nephropathy, hemolytic uremic syndrome and Henoch- Schonlein purpura may also occur. Acute interstitial nephritis and acute tubular dysfunction secondary to  Salmonella typhimurium Scientific Name Search has been reported in children and adults either in isolation or with schistosomiasis. [2] Renal failure secondary to rhabdomyolysis has also been reported.

Glomerulonephritis is uncommon. [3] Immune complex glomerulitis, with deposition of immunoglobulins and C3 globulin, is seen in these patients. Salmonella Vi antigen was also found in the glomerular capillary wall, suggesting the direct role of Salmonella typhi in the pathogenesis of the glomerular lesion. [4] The present case showed diffuse proliferative glomerulonephritis in renal biopsy. Buka et al., showed patients with typhoid nephritis compared to post- streptococcal glomerulonephritis (PSGN) have edema for prolonged periods before admission, are likely to be febrile and have splenomegaly. C3 levels are lower in PSGN patients (P < 0.01), [5] findings similar to this case.

 
  References Top

1.Parmar RC, Bavdekar SB, Houilgol R, Muranjan MN. Nephritis and cerebellar ataxia: rare presenting features of enteric fever. J Postgrad Med 2000;46:184-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Deshpande PV, Gilbert RD. Acute renal tubular dysfunction in association with Salmonella enteritidis. Indian Pediatr 2004;41:395-6.  Back to cited text no. 2
    
3.Hayashi M, Kouzu H, Nishihara M, Takahashi T, Furuhashi M, Sakamoto K, et al. Acute renal failure likely due to acute nephritic syndrome associated with typhoid fever. Intern Med 2005;44:1074-7.  Back to cited text no. 3
    
4.Sitprija V, Pipatanagul V, Boonpucknavig V, Boonpucknavig S. Glomerulitis in typhoid fever. Ann Intern Med 1974;81:210-3.  Back to cited text no. 4
    
5.Buka I, Coovadia HM. Typhoid glomerulonephritis. Arch Dis Child 1980;55:305-7.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 

    

Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07