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Jesús Izquierdo-Ortiz, Badawi Hijazi-Prieto, Isabel Sáez-Calero, Javier Santos-Barajas, Pedro Abaigar-Luquin" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Verónica" "apellidos" => "Mercado-Valdivia" "email" => array:1 [ 0 => "veronicamercado2@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Vanesa" "apellidos" => "Camarero-Temiño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "M. Jesús" "apellidos" => "Izquierdo-Ortiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Badawi" "apellidos" => "Hijazi-Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Isabel" "apellidos" => "Sáez-Calero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Javier" "apellidos" => "Santos-Barajas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "nombre" => "Pedro" "apellidos" => "Abaigar-Luquin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario de Burgos, Burgos, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adulto senil y glomerulonefritis aguda posinfecciosa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11581_16025_35742_en_t111581.jpg" "Alto" => 1172 "Ancho" => 2214 "Tamanyo" => 709406 ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory values" ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Acute post-infectious glomerulonephritis (APGN) is primarily a disease found in infants that occurs following infection of the respiratory tract or impetigo.<span class="elsevierStyleSup">1,2</span></p><p class="elsevierStylePara">This disease is uncommon in older patients, but aging has become an important risk factor. Four decades ago, only 4%-6% of adults with APGN were older than 65 years of age, compared to 34% in recent reports.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Comorbidities such as decreased renal function, diabetes mellitus, arterial hypertension, hyperlipidaemia, cardiovascular disease, and neoplasia contribute to the modification of the clinical presentation and natural progression of this condition. APGN is present in 3%-6% of biopsies, and is often an unexpected finding. Renal function is recovered within 3-4 weeks in 95% of cases, although this rate is much less predictable in the elderly.<span class="elsevierStyleSup">1,3,4</span></p><p class="elsevierStylePara">The treatment of APGN is based on antibiotics, diuretics, hypotensive drugs, and occasionally haemodialysis.<span class="elsevierStyleSup">2,5</span></p><p class="elsevierStylePara">We present four cases of patients older than 55 years with acute renal failure and nephritic syndrome, three of which were preceded by a respiratory infection and substantially elevated creatinine levels, and the fourth of which had nephritic/nephrotic syndrome with no prior infection and conserved renal function.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case A:</span> A 59-year-old male with chronic kidney disease (CKD) and rheumatoid arthritis, hospitalised due to nephritic syndrome in the context of a cutaneous infection by methicillin-resistant <span class="elsevierStyleItalic">S. aureus</span> (MRSA) and a respiratory infection. Specific antibiotic treatment was administered with no improvements in clinical or laboratory parameters.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case B:</span> A 64-year-old male with no prior symptoms, hospitalised due to nephritic syndrome with normal renal function. During hospital stay, treatment was administered with diuretics, which improved the symptoms, although successive consultations revealed persistent microhaematuria and nephrotic-range proteinuria with p-ANCA (+).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case C:</span> An 80-year-old male with CKD, hospitalised due to macroscopic haematuria and severe deterioration in renal function with a very recent history of respiratory infection. Antibiotic treatment was administered with improved respiratory symptoms, but worsening renal function.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case D:</span> An 83-year-old male, hospitalised due to nephritic/nephrotic syndrome in the context of epididymitis and respiratory infection several days after a transurethral resection. The patient progressed poorly under treatment with antibiotics and diuretics.</p><p class="elsevierStylePara">All patients underwent complementary testing to determine the microbiological aetiology of the infections, with MRSA found in only one case. Given the persistent deterioration of renal function despite treatment with antibiotics and diuretics, a renal biopsy was taken.</p><p class="elsevierStylePara">All four biopsies led to a diagnosis of APGN.</p><p class="elsevierStylePara">In case B, the patient without deteriorated renal function, the same diagnosis was reached but in the recovery phase. In the other three cases, corticosteroid treatment was started with a positive response in one patient, case A.</p><p class="elsevierStylePara">However, in cases C and D, the patients failed to recover renal function and remained on a programme of periodical haemodialysis; one of these patients still retains residual diuresis after 8 months on haemodialysis.</p><p class="elsevierStylePara">To conclude, in the presence of nephritic syndrome, one differential diagnosis that must not be forgotten is APGN, despite the fact that this pathology is uncommon in the adult-senile population. We must keep in mind the personal history of these patients and any predisposing factors that would compromise the immune system, since it has been reported that these factors affect the susceptibility of a given patient to developing this pathology.<span class="elsevierStyleSup">3,6</span></p><p class="elsevierStylePara">Severe renal deterioration is the first form of presentation of this condition and is associated with older age, implying poor prognosis and patient evolution. As such, it is of vital importance to keep this differential diagnosis in mind when treating senile patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara"><a href="grande/11581_16025_35742_en_t111581.jpg" class="elsevierStyleCrossRefs"><img src="11581_16025_35742_en_t111581.jpg" alt="Clinical and laboratory values"></img></a></p><p class="elsevierStylePara">Table 1. Clinical and laboratory values</p>" "pdfFichero" => "P1-E543-S3700-A11581-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11581_16025_35742_en_t111581.jpg" "Alto" => 1172 "Ancho" => 2214 "Tamanyo" => 709406 ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory values" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nast CC Infection-related glomerulonephritis: changing demographics and outcomes. Adv Chronic Kidney Dis 2012;19(2):68-75. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22449343" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Couser WG. Glomerulonephritis. Lancet 1999;353(9163):1509-15." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nasr SH, Fidler ME, Valeri AM, Cornell LD, Sethi S, Zoller A. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol 2011;22:187-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21051737" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wen YK, Chen ML. The significance of atypical morphology in the changes of spectrum of postinfectious glomerulonephritis. Clin Nephrol 2010;73(3):173-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20178715" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rodríguez-Iturbe B. Glomerulonefritis endocapilar aguda. In: Hernando L, Aljama P, Arias M (ed.). Nefrología Clínica, 2.ª ed. Madrid: Editorial Médica Panamericana; 2004. p. 308-14." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Clinicopathological study of infection-associated glomerulonephritis in adults. Yao-Ko Wen. Int Urol Nephrol 2010;42:477-85" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wen YK. The spectrum of adult postinfectious glomerulonephritis in the new millennium.\u{A0}Ren Fail 2009;31(8):676-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19814634" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001767/v0_201502091607/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000005/v0_201502091606/X2013251412001767/v0_201502091607/en/P1-E543-S3700-A11581-EN.pdf?idApp=UINPBA000064&text.app=https://www.revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001767?idApp=UINPBA000064" ]
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2020 October | 33 | 20 | 53 |
2020 September | 49 | 9 | 58 |
2020 August | 36 | 10 | 46 |
2020 July | 38 | 10 | 48 |
2020 June | 52 | 11 | 63 |
2020 May | 46 | 13 | 59 |
2020 April | 36 | 18 | 54 |
2020 March | 44 | 11 | 55 |
2020 February | 58 | 14 | 72 |
2020 January | 55 | 22 | 77 |
2019 December | 73 | 20 | 93 |
2019 November | 45 | 23 | 68 |
2019 October | 39 | 9 | 48 |
2019 September | 46 | 24 | 70 |
2019 August | 28 | 10 | 38 |
2019 July | 35 | 24 | 59 |
2019 June | 32 | 24 | 56 |
2019 May | 41 | 18 | 59 |
2019 April | 89 | 23 | 112 |
2019 March | 40 | 24 | 64 |
2019 February | 24 | 14 | 38 |
2019 January | 28 | 20 | 48 |
2018 December | 84 | 35 | 119 |
2018 November | 121 | 16 | 137 |
2018 October | 125 | 10 | 135 |
2018 September | 72 | 17 | 89 |
2018 August | 56 | 18 | 74 |
2018 July | 64 | 16 | 80 |
2018 June | 71 | 11 | 82 |
2018 May | 89 | 12 | 101 |
2018 April | 62 | 10 | 72 |
2018 March | 70 | 10 | 80 |
2018 February | 60 | 14 | 74 |
2018 January | 44 | 5 | 49 |
2017 December | 61 | 11 | 72 |
2017 November | 44 | 9 | 53 |
2017 October | 38 | 10 | 48 |
2017 September | 32 | 7 | 39 |
2017 August | 36 | 8 | 44 |
2017 July | 31 | 10 | 41 |
2017 June | 33 | 26 | 59 |
2017 May | 47 | 10 | 57 |
2017 April | 48 | 13 | 61 |
2017 March | 36 | 9 | 45 |
2017 February | 39 | 10 | 49 |
2017 January | 35 | 13 | 48 |
2016 December | 63 | 9 | 72 |
2016 November | 73 | 7 | 80 |
2016 October | 116 | 9 | 125 |
2016 September | 166 | 8 | 174 |
2016 August | 183 | 9 | 192 |
2016 July | 177 | 10 | 187 |
2016 June | 133 | 0 | 133 |
2016 May | 130 | 0 | 130 |
2016 April | 103 | 0 | 103 |
2016 March | 116 | 0 | 116 |
2016 February | 98 | 0 | 98 |
2016 January | 88 | 0 | 88 |
2015 December | 118 | 0 | 118 |
2015 November | 103 | 0 | 103 |
2015 October | 79 | 0 | 79 |
2015 September | 80 | 0 | 80 |
2015 August | 87 | 0 | 87 |
2015 July | 82 | 0 | 82 |
2015 June | 50 | 0 | 50 |
2015 May | 40 | 0 | 40 |
2015 April | 5 | 0 | 5 |