Infection-Related Glomerulonephritis in a Transplanted Kidney

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Journal of the American Society of Nephrology

Abstract

Introduction: Glomerular disease is the third leading cause of kidney allograft loss. Despite infections being common after transplant, infection-related glomerulonephritis (IRGN) is rare. We present a case of biopsy proven IRGN in an allograft following a methicillin-susceptible Staphylococcus aureus infection.

Case Description: A 66-year-old female with CKD5 due to type 1 diabetes, who underwent a simultaneous kidney and pancreas transplant in 2011. Subsequently she had an unremarkable post-transplant course with a baseline creatinine of 1.0 mg/dL. In 2025, she had a left first metatarsal head amputation complicated by methicillin-susceptible staphylococcus aureus (MSSA) infection resulting in osteomyelitis. She initiated therapy with clindamycin. One week later, she presents with exertional dyspnea and bilateral leg edema. Her white count was 15 K/mcl and her creatinine was 3.3 mg/dL. Despite an unremarkable transplant kidney ultrasound, a negative DSA, and therapeutic tacrolimus levels, she became anuric. Her C3 level was low at 63 mg/dL. Transplant biopsy revealed endocapillary hypercellularity with neutrophilic and monocytic infiltration without tubulitis or arteritis. C4D stain was unremarkable. Immunofluorescence was significant for C3 and IgA with IgG to a lesser extent. Electron microscopy showed subendothelial electron dense deposits. The biopsy was consistent with IRGN. Hemodialysis was initiated and the patient was discharged home on oral antibiotics and continued hemodialysis for AKI.

Discussion: Glomerular disease following kidney transplant is a frequent cause of kidney failure ranging from 18 to 30%. It is usually due to recurrence of the native disease. Infection in transplant recipients is common, with 70% of recipients experiencing some form of infection within 3 years following transplantation. Despite infections in immunosuppressed patients being common, IRGN remains rare. The reported cases describe a variety of causative organisms, including MSSA, E. Coli, and Herpes Simplex Virus. In five reported cases, two required chronic hemodialysis, one required temporary hemodialysis and three patients had complete renal recovery. Given the high incidence of infections after kidney transplantation and how little data is available regarding IRGN in kidney transplant recipients, further research in this area is essential to improve outcomes and prevent allograft loss.

Volume

36

Issue

10S

Comments

Kidney Week 2025, American Society of Nephrology Meeting, November 5-9, 2025, Houston, TX

DOI

10.1681/ASN.2025s70te5pf

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