Abstract
We describe a 13-year-old boy who presented with hematuria and intermittent low-grade proteinuria at the time when he was diagnosed with cat scratch disease. Two months before presentation, he had a negative urinalysis during a routine physical evaluation. He continued to have microscopic hematuria for the next 6 months, when he developed gross hematuria and recurrence of low-grade proteinuria. The renal biopsy showed evidence of mild/moderate IgA nephropathy. We speculate that the immunological changes associated with cat scratch disease in this patient may have triggered the development of IgA nephropathy. A history or serological evidence of infection with Bartonella henselae may need to be sought in patients presenting with IgA nephritis.
References
Allen AC, Bailey EM, Brenchley PE, Buck KS, Barratt J, Feehally J (2001) Mesangial IgA1 in IgA nephropathy exhibits aberrant O-glycosylation: observations in three patients. Kidney Int 60:969–973
Tomana M, Novak J, Julian BA, Matousovic K, Konecny K, Mestecky J (1999) Circulating immune complexes in IgA nephropathy consist of IgA1 with galactose-deficient hinge region and antiglycan antibodies. J Clin Invest 104:73–81
Hiki Y, Kokubo T, Iwase H, Masaki Y, Sano T, Tanaka A, Toma K, Hotta K, Kobayashi Y (1999) Underglycosylation of IgA1 hinge plays a certain role for its glomerular deposition in IgA nephropathy. J Am Soc Nephrol 10:760–769
Laurent J, Branellec A, Heslan JM, Rostoker G, Bruneau C, Andre C, Intrator L, Lagrue G (1987) An increase in circulating IgA antibodies to gliadin in IgA mesangial glomerulonephritis. Am J Nephrol 7:178–183
Fujieda M, Kinoshita A, Naruse K, Nakayama T, Moriki T, Wakiguchi H, Kurashige T (2000) Mumps associated with immunoglobulin A nephropathy. Pediatr Infect Dis J 19:669–671
Ortmanns A, Ittel TH, Schnitzler N, Handt S, Helmchen U, Sieberth G (1998) Remission of IgA nephropathy following treatment of cytomegalovirus infection with ganciclovir. Clin Nephrol 49:379–384
Muller GA, Muller CA, Engler-Blum G, Kuhn W, Risler T, Bohle A, Markovic-Lipkovski J (1992) Human cytomegalovirus in immunoglobulin A nephropathy: detection by polymerase chain reaction. Nephron 62:389–393
Allen AC, Willis FR, Beattie TJ, Feehally J (1998) Abnormal IgA glycosylation in Henoch-Schonlein purpura restricted to patients with clinical nephritis. Nephrol Dial Transplant 13:930–934
Ayoub EM, McBride J, Schmiederer M, Anderson B (2002) Role of Bartonella henselae in the etiology of Henoch-Schonlein purpura. Pediatr Infect Dis J 21:28–31
D’Agati V, McEachrane S, Dicker R, Nielsen E (1990) Cat scratch disease and glomerulonephritis. Nephron 56:431–435
Holmes AH, Greenough TC, Balady GJ, Regnery RL, Anderson BE, O’Keane JC, Fonger JD, McCrone EL (1995) Bartonella henselae endocarditis in an immunocompetent adult. Clin Infect Dis 21:1004–1007
Wolach B, Uziel Y, Berger I, Pomeranz A (1990) Cat-scratch bacillus and Streptococcus pneumoniae causing submandibular suppurative adenitis and acute glomerulonephritis. Child Nephrol Urol 10:158–160
Bass JW, Freitas BC, Freitas AD, Sisler CL, Chan DS, Vincent JM, Person DA, Claybough JA, Wittler RR, Weisse ME, Regnery RL, Slater LN (1998) Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease. Pediatr Infect Dis J 17:447–452
Arisoy E, Correa JA, Wagner M, Kaplan S (1998) Hepatosplenic cat-scratch disease in children: selected clinical features and treatment (abstract 47). Clin Infect Dis 27:928
Amore A, Cirina P, Conti G, Brusa P, Peruzzi L, Coppo R (2001) Glycosylation of circulating IgA in patients with IgA nephropathy modulates proliferation and apoptosis of mesangial cells. J Am Soc Nephrol 12:1862–1871
Feehally J, Allen AC (1999) Pathogenesis of IgA nephropathy. Ann Med Interne (Paris) 150:91–98
Feehally J, Allen AC (1999) Structural features of IgA molecules which contribute to IgA nephropathy. J Nephrol 12:59–65
Matsuda M, Shikata K, Wada J, Sugimoto H, Shikata Y, Kawasaki T, Makino H (1998) Deposition of mannan binding protein and mannan binding protein-mediated complement activation in the glomeruli of patients with IgA nephropathy. Nephron 80:408–413
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hopp, L., Eppes, S.C. Development of IgA nephritis following cat scratch disease in a 13-year-old boy. Pediatr Nephrol 19, 682–684 (2004). https://doi.org/10.1007/s00467-004-1432-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-004-1432-1