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2015 ; 4
(1
): 112-116
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A case of post-pneumococcal acute glomerulonephritis with glomerular depositions
of nephritis-associated plasmin receptor
#MMPMID28509278
Odaka J
; Kanai T
; Ito T
; Saito T
; Aoyagi J
; Betsui H
; Oda T
; Ueda Y
; Yamagata T
CEN Case Rep
2015[May]; 4
(1
): 112-116
PMID28509278
show ga
We report the case of a 12-year-old girl who was referred to our hospital with
anuria associated with pneumonia. On admission, the patient's blood test results
revealed severe renal failure, hypoproteinemia, and hypocomplementemia. Her
urinalysis results revealed hematuria, proteinuria, and a positive titer for
Streptococcus pneumoniae. S. pneumoniae was also detected in her sputum and blood
cultures. The patient was diagnosed with post-pneumococcal acute
glomerulonephritis (AGN) with acute renal failure. A renal biopsy demonstrated
the infiltration of neutrophils and mononuclear cells into capillary loops.
Immunofluorescence studies showed dominant-positive deposition of C3c along the
capillary loops and nephritis-associated plasmin receptor (NAPlr) depositions in
the mesangial area and capillary loops. Electron microscopy revealed dense
deposits in the glomerular basement membrane without a hump in the subepithelial
area. These findings were consistent with endocapillary proliferative
glomerulonephritis. AGN associated with pneumococcal infection is very rare. This
case suggests that NAPlr is the causative antigen not only of post-streptococcal
AGN, but also of post-pneumococcal AGN. To our knowledge, this is the first
report that shows a relationship between post-pneumococcal AGN and NAPlr
depositions in the glomeruli.