A prolonged course of Group A streptococcus-associated nephritis: a mild case of dense deposit disease (DDD)?

Clin Nephrol. 2009 Jun;71(6):703-7. doi: 10.5414/cnp71703.

Abstract

We herein report the case of a 12-year-old boy with dense deposit disease (DDD) evoked by streptococcal infection. He had been diagnosed to have asymptomatic hematuria syndrome at the age of 6 during school screening. At 12 years of age, he was found to have macrohematuria and overt proteinuria with hypocomplementemia 2 months after streptococcal pharyngitis. Renal biopsy showed endocapillary proliferative glomerulonephritis with double contours of the glomerular basement membrane. Hypocomplementemia and proteinuria were sustained for over 8 weeks. He was suspected to have dense deposit disease due to intramembranous deposits in the first and the second biopsies. 1 month after treatment with methylprednisolone pulse therapy, proteinuria decreased to a normal level. Microscopic hematuria disappeared 2 years later, but mild hypocomplementemia persisted for more than 7 years. Nephritis-associated plasmin receptor (NAPlr), a nephritic antigen for acute poststreptococcal glomerulonephritis, was found to be positive in the glomeruli for more than 8 weeks. DDD is suggested to be caused by dysgeneration of the alternative pathway due to C3NeF and impaired Factor H activity. A persistent deposition of NAPlr might be one of the factors which lead to complement dysgeneration. A close relationship was suggested to exist between the streptococcal infection and dense deposit disease in this case.

Publication types

  • Case Reports

MeSH terms

  • Antigens, Bacterial / ultrastructure
  • Child
  • Glomerulonephritis, Membranoproliferative / diagnosis
  • Glomerulonephritis, Membranoproliferative / drug therapy
  • Glomerulonephritis, Membranoproliferative / immunology
  • Glomerulonephritis, Membranoproliferative / microbiology*
  • Glucocorticoids / administration & dosage
  • Hematuria / drug therapy
  • Hematuria / microbiology
  • Humans
  • Kidney / immunology
  • Kidney / pathology
  • Kidney / ultrastructure
  • Male
  • Methylprednisolone / administration & dosage
  • Proteinuria / drug therapy
  • Proteinuria / microbiology
  • Pulse Therapy, Drug
  • Receptors, Cell Surface / ultrastructure
  • Severity of Illness Index
  • Streptococcal Infections / complications*
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / immunology
  • Streptococcus pyogenes / immunology

Substances

  • Antigens, Bacterial
  • Glucocorticoids
  • Receptors, Cell Surface
  • nephritis-associated plasminogen receptor, Streptococcus
  • Methylprednisolone