Staphylococcus-Related Glomerulonephritis and Poststreptococcal Glomerulonephritis: Why Defining “Post” Is Important in Understanding and Treating Infection-Related Glomerulonephritis

• Published in: American journal of kidney diseases Vol. 65; no. 6; pp. 826 - 832
• Main Authors: Glassock, Richard J., MD, Alvarado, Anthony, MD, Prosek, Jason, MD, Hebert, Courtney, MD, Parikh, Samir, MD, Satoskar, Anjali, MD, Nadasdy, Tibor, MD, Forman, John, MD, Rovin, Brad, MD, Hebert, Lee A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: Adrenal Cortex Hormones - therapeutic use; Anti-Bacterial Agents - therapeutic use; Glomerulonephritis - classification; Glomerulonephritis - drug therapy; Glomerulonephritis - etiology; Humans; kidney biopsy; latent period; medical error; Methicillin-Resistant Staphylococcus aureus; Nephrology; nomenclature; nosology; post-infectious glomerulonephritis; Post-staphylococcal glomerulonephritis; renal disease; Staphylococcal Infections - complications; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcus aureus; steroid treatment; Streptococcal Infections - complications; Terminology as Topic; nomenclature; steroid treatment; kidney biopsy; nosology; medical error; post-infectious glomerulonephritis; Post-staphylococcal glomerulonephritis; latent period; renal disease
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2015.01.023

A spate of recent publications describes a newly recognized form of glomerulonephritis associated with active staphylococcal infection. The key kidney biopsy findings, glomerular immunoglobulin A (IgA) deposits dominant or codominant with IgG deposits, resemble those of IgA nephritis. Many authors describe this condition as “postinfectious” and have termed it “poststaphylococcal glomerulonephritis.” However, viewed through the prism of poststreptococcal glomerulonephritis, the prefix “post” in poststaphylococcal glomerulonephritis is historically incorrect, illogical, and misleading with regard to choosing therapy. There are numerous reports describing the use of high-dose steroids to treat poststaphylococcal glomerulonephritis. The decision to use steroid therapy suggests that the treating physician believed that the dominant problem was a postinfectious glomerulonephritis, not the infection itself. Unfortunately, steroid therapy in staphylococcus-related glomerulonephritis can precipitate severe staphylococcal sepsis and even death and provides no observable benefits. Poststreptococcal glomerulonephritis is an authentic postinfectious glomerulonephritis; poststaphylococcal glomerulonephritis is not. Making this distinction is important from the perspective of history, pathogenesis, and clinical management.