IgA Dominant Post-infectious Glomerulonephritis in a 12-year-old Child

To the Editor: Post-infectious glomerulonephritis (PIGN) is an immune-mediated glomerulonephritis that commonly follows Streptococcal infection [1]. IgA-dominant PIGN is an increasingly recognized variant of PIGN described mostly in the elderly and diabetic adults [2]. A 12-y-old girl presented with cola-colored urine, oliguria and anasarca for 10 d. There was no history of rash, pyodermas, pharyngitis or burning micturition. At admission, she was afebrile; the blood pressure was 150/ 100 mm Hg (>95th centile). Anasarca was noted. Other systemic examination was normal. Blood urea was 186 mg/dl and creatinine was 5.2 mg/dl. Urinalysis showed 4+ albuminuria and red blood cell casts. C3 and C4 complement levels were low. Antistreptolysin (ASO) titres were less than 200 IU/ml; antinuclear antibodies (ANA), antinuclear cytoplasmic antibodies (ANCA) and HIV serology were negative. Blood culture was sterile. In view of rapidly progressive glomerulonephritis (RPGN), intravenous methylprednisolone pulse therapy for 5 d was administered followed by oral prednisolone. Renal histopathology revealed IgA-dominant PIGN (Figs. 1 and 2). After seven sessions of hemodialysis over 2 wk, the urine output normalized. Serial blood glucose values were normal. She was discharged after 4 wk on prednisolone. At discharge, serum creatinine was 1.9 mg/dl. At 3 mo follow-up, serum creatinine was 0.8 mg/dl, with no proteinuria, hematuria or hypertension. Predisposing conditions for IgA-dominant PIGN include old age, diabetes, Staphylococcus aureus infections, malignancy, intravenous drug abuse, alcoholism, HIV infection and atopic dermatitis [1]. The histopathological features of IgA-dominant PIGN are similar to classical post-streptococcal glomerulonephritis, except that there is co-dominant IgA and IgG deposition with stronger staining for C3 compared to IgA [3]. IgAdominant PIGN has been reported only twice below 18 y of age; the youngest being a 16-y-old child [4]. There is no consensus on management of this entity. Many authors have suggested antibiotics for associated urinary tract infections or systemic infections [5]. IgAdominant PIGN has been reported in the absence of systemic infections too, as in our case [2]. Steroids are * Sriram Krishnamurthy drsriramk@yahoo.com