Chapter

Infection-associated nephropathies

A Neil Turner

in Oxford Textbook of Medicine

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199204854
Published online May 2011 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.211007_update_001
Infection-associated nephropathies

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Infection may be a primary cause of renal disease (e.g. postinfectious glomerulonephritis) or affect the kidneys on a background of debilitating illnesses and previous medical interventions. Renal disease may arise as a consequence of immune responses to a pathogen, direct invasion by the microorganism, or the effects of infection on the systemic or local circulations.

Glomerulonephritis—associated with chronic and acute bacterial infections. Shunt nephritis follows colonization of a ventriculoatrial shunt, most commonly with Staphylococcus epidermidis, which leads to constitutional symptoms, an acute inflammatory response, and (most characteristically) a type 1 mesangiocapillary glomerulonephritis; treatment requires removal of the shunt. Infective endocarditis and other deep-seated bacterial infections may produce a renal picture similar to shunt nephritis; they can mimic vasculitic syndromes and outcome is dependent on the response of the infection to treatment. Acute postinfectious glomerulonephritis—see Chapter 21.8.5.

Interstitial nephritis—bacteria that can cause this include leptospira (Weil’s disease), Rickettsia rickettsii (Rocky Mountain spotted fever), legionella, and mycobacteria. Viral infections include hantaviruses (haemorrhagic fever with renal syndrome and nephropathia epidemica) and, almost exclusively following renal transplantation, cytomegalovirus and polyomavirus hominis type 1 (BK) virus.

HIV-associated renal disorders—these include HIV nephropathy, a focal segmental glomerulosclerosis of the ‘collapsing’ form, occurring almost exclusively in black patients; it is the third most frequent cause of endstage renal failure in black adults of working age in the United States of America.

Hepatitis B virus—chronic infection is strongly associated with membranous nephropathy; affected individuals are HBeAg and HBsAg positive, usually with coexistent hepatitis; seroconversion from HBeAg positive to HBeAb positive (naturally or induced by treatment) is associated with remission of the renal lesion.

Hepatitis C virus—chronic infection is the commonest cause of mixed essential (type II) cryoglobulinaemia in most populations; it is associated with mesangiocapillary glomerulonephritis, and reduction of viral replication has been associated with disease remission.

Chapter.  4622 words.  Illustrated.

Subjects: Nephrology

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