IgA-dominant infection-related glomerulonephritis with oxalate deposition: A case report and literature review

doi:10.3969/j.issn.1004-583X.2025.02.012

Abstract

Abstract:

Objective This article reports a patient who developed immunoglobulin A (IgA)-dominant infection-related glomerulonephritis (IgA-IRGN) with oxalate deposition following skin burns, ulceration, scab formation, and healing caused by folk remedies for arthritis. To observe the clinicopathological features and explore the correlation between the heart, kidney and joint lesions. Methods After admission, the patient underwent echocardiography, knee joint magnetic resonance imaging (MRI), renal biopsy, and culture of synovial fluid from the joint cavity. The clinical and pathological characteristics were observed, and the outcomes after treatment were analyzed. Results The patient's condition improved after treatment with anti-infective therapy, proteinuria reduction, and cardiac function improvement. Conclusion IgA-IRGN is commonly seen in elderly individuals with type 2 diabetes and immunodeficiency. However, this case did not involve these underlying conditions. The patient presented with nephrotic syndrome, acute kidney injury, osteoarthritis, severe mitral regurgitation, and mitral valve prolapse. The condition is further complicated by the coexistence of multiple diseases. When the infection source of IgA-IRGN is occult, clinical misdiagnosis and missed diagnosis are common. Therefore, increased vigilance is needed during diagnosis and treatment.

Key words: glomerulonephritis, IGA, Staphylococcus aureus, osteoarthritis

CLC Number:

R692.31

Zhao Hui, Zhang Pengwei, Zhang Jian, Huang Wenhui, Li Xiaoli, Ma Zhigang, Jin Fang, Tian Limin. IgA-dominant infection-related glomerulonephritis with oxalate deposition: A case report and literature review[J]. Clinical Focus, 2025, 40(2): 162-167.

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URL: https://lchc.magtechjournal.com/EN/10.3969/j.issn.1004-583X.2025.02.012

https://lchc.magtechjournal.com/EN/Y2025/V40/I2/162

Figures/Tables 5

Fig.1 Erythematous skin changes a. Skin ulceration and scab healing at scapula with detached scabs; b. Skin scab under popliteal fossa of the right lower limb

Fig.2 Knee joint images a, b. Anterior and lateral plain films of the left knee joint show narrowed joint space and multiple osteophytes; c, d. MRI of left knee joint shows uneven thickness of articular cartilage, swelling of medial meniscus and injury of cruciate ligament

Fig.3 Patient renal pathology a. Glomerular capillary loops are narrow, with proliferating endothelial and mesangial cells, blue arrow shows small cell crescent body, green arrow shows neutrophil infiltration (HE×200); b. Red cell tube type can be seen in renal tubule lumen (HE×100); c. Disc crystals can be seen in the renal tubule lumen, and double refraction phenomenon can be seen under polarized light (polarized light ×100); d1, d2. IgA, C3 show coarse granular deposition along the capillary wall and mesangial region, and the intensity of C3 is higher than IgA (immunofluorescence ×200); e. Arrow shows the hump-like electron dense deposits under glomerular epithelium (electron microscope ×5000)

Fig.4 Immunofluorescence staining a. IgA immunofluorescence staining (×400) ; b. KM55 for immunofluorescence staining (×400); c. ab image fusion (immunofluorescence ×400) ; d. KM55 for positive control (immunofluorescence ×400) in IgA nephropathy patients

Tab.1 Changes in laboratory indicators before and after treatment

指标	时间
指标	入院前半月	入院时	入院后第2 d	入院后第3 d	入院后第4 d	入院后第7 d	入院后第9 d	入院后2周	入院后2个月
白细胞(×10⁹/L)	7.51	8.9	-	5.7	-	10.6	13.1	10.5	8.5
血红蛋白(g/L)	131	115	-	116	-	107	109	100	115
血小板(×10⁹/L)	309	390	-	436	-	431	396	136	367
白蛋白(g/L)	30	24.37	-	26.9	-	30.2	32.7	31.6	36
尿素氮(mmol/L)	42.1	42.6	54.9	42	44.89	44.9	34.3	16.9	12
血肌酐(μmol/L)	752	453.8	431	346	337	200	141.3	109.7	85
Ca(mmol/L)	2.11	1.93	1.82	1.9	2.1	2.2	2.14	1.94	1.98
P(mmol/L)	1.55	1.9	-	-	-	-	-	-	-
K(mmol/L)	5.39	5.4	5.1	5.3	5.1	4.8	4.5	3.5	4.2
CRP(mg/L)	49.8	127.6	-	105	-	27.7	15.2	-	12
PCT(ng/ml)	-	1.316	-	-	-	0.078	-	0.090	-
血沉(mm/h)	89	-	61	-	-	-	-	8	6
C3(g/L)	-	-	0.2	-	-	-	-	0.4	0.6
24h-UP(g/24h)	-	-	-	4.93	-	-	-	2.75	0.8

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