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    "textoCompleto" => "<p class="elsevierStylePara">Acute post-infectious glomerulonephritis &#40;APGN&#41; is primarily a disease found in infants that occurs following infection of the respiratory tract or impetigo&#46;<span class="elsevierStyleSup">1&#44;2</span></p><p class="elsevierStylePara">This disease is uncommon in older patients&#44; but aging has become an important risk factor&#46; Four decades ago&#44; only 4&#37;-6&#37; of adults with APGN were older than 65 years of age&#44; compared to 34&#37; in recent reports&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Comorbidities such as decreased renal function&#44; diabetes mellitus&#44; arterial hypertension&#44; hyperlipidaemia&#44; cardiovascular disease&#44; and neoplasia contribute to the modification of the clinical presentation and natural progression of this condition&#46; APGN is present in 3&#37;-6&#37; of biopsies&#44; and is often an unexpected finding&#46; Renal function is recovered within 3-4 weeks in 95&#37; of cases&#44; although this rate is much less predictable in the elderly&#46;<span class="elsevierStyleSup">1&#44;3&#44;4</span></p><p class="elsevierStylePara">The treatment of APGN is based on antibiotics&#44; diuretics&#44; hypotensive drugs&#44; and occasionally haemodialysis&#46;<span class="elsevierStyleSup">2&#44;5</span></p><p class="elsevierStylePara">We present four cases of patients older than 55 years with acute renal failure and nephritic syndrome&#44; three of which were preceded by a respiratory infection and substantially elevated creatinine levels&#44; and the fourth of which had nephritic&#47;nephrotic syndrome with no prior infection and conserved renal function&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case A&#58;</span> A 59-year-old male with chronic kidney disease &#40;CKD&#41; and rheumatoid arthritis&#44; hospitalised due to nephritic syndrome in the context of a cutaneous infection by methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;MRSA&#41; and a respiratory infection&#46; Specific antibiotic treatment was administered with no improvements in clinical or laboratory parameters&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case B&#58;</span> A 64-year-old male with no prior symptoms&#44; hospitalised due to nephritic syndrome with normal renal function&#46; During hospital stay&#44; treatment was administered with diuretics&#44; which improved the symptoms&#44; although successive consultations revealed persistent microhaematuria and nephrotic-range proteinuria with p-ANCA &#40;&#43;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case C&#58;</span> An 80-year-old male with CKD&#44; hospitalised due to macroscopic haematuria and severe deterioration in renal function with a very recent history of respiratory infection&#46; Antibiotic treatment was administered with improved respiratory symptoms&#44; but worsening renal function&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case D&#58;</span> An 83-year-old male&#44; hospitalised due to nephritic&#47;nephrotic syndrome in the context of epididymitis and respiratory infection several days after a transurethral resection&#46; The patient progressed poorly under treatment with antibiotics and diuretics&#46;</p><p class="elsevierStylePara">All patients underwent complementary testing to determine the microbiological aetiology of the infections&#44; with MRSA found in only one case&#46; Given the persistent deterioration of renal function despite treatment with antibiotics and diuretics&#44; a renal biopsy was taken&#46;</p><p class="elsevierStylePara">All four biopsies led to a diagnosis of APGN&#46;</p><p class="elsevierStylePara">In case B&#44; the patient without deteriorated renal function&#44; the same diagnosis was reached but in the recovery phase&#46; In the other three cases&#44; corticosteroid treatment was started with a positive response in one patient&#44; case A&#46;</p><p class="elsevierStylePara">However&#44; in cases C and D&#44; the patients failed to recover renal function and remained on a programme of periodical haemodialysis&#59; one of these patients still retains residual diuresis after 8 months on haemodialysis&#46;</p><p class="elsevierStylePara">To conclude&#44; in the presence of nephritic syndrome&#44; one differential diagnosis that must not be forgotten is APGN&#44; despite the fact that this pathology is uncommon in the adult-senile population&#46; We must keep in mind the personal history of these patients and any predisposing factors that would compromise the immune system&#44; since it has been reported that these factors affect the susceptibility of a given patient to developing this pathology&#46;<span class="elsevierStyleSup">3&#44;6</span></p><p class="elsevierStylePara">Severe renal deterioration is the first form of presentation of this condition and is associated with older age&#44; implying poor prognosis and patient evolution&#46; As such&#44; it is of vital importance to keep this differential diagnosis in mind when treating senile patients&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11581&#95;16025&#95;35742&#95;en&#95;t111581&#46;jpg" class="elsevierStyleCrossRefs"><img src="11581_16025_35742_en_t111581.jpg" alt="Clinical and laboratory values"></img></a></p><p class="elsevierStylePara">Table 1&#46; Clinical and laboratory values</p>"
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