A case of kidney disease related to Staphylococcus epidermidis infection soon after insertion of a central venous catheter.

IF 0.7 Q4 UROLOGY & NEPHROLOGY
Kei Kono, Naoki Sawa, Daisuke Ikuma, Yuki Oba, Hiroki Mizuno, Akinari Sekine, Noriko Inoue, Kiho Tanaka, Masayuki Yamanouchi, Eiko Hasegawa, Tatsuya Suwabe, Takeshi Fujii, Yutaka Takazawa, Kenichi Ohashi, Yutaka Yamaguchi, Takehiko Wada, Yoshifumi Ubara
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引用次数: 0

Abstract

Central venous catheter (CVC)-related kidney disease has been well documented in cases of long-term catheter use, typically manifesting as membranoproliferative glomerulonephritis with immunoglobulin (Ig)M and C3 deposits after months to years of catheterization. We report an exceptional case of rapidly progressive kidney disease that developed just 7 days after CVC insertion in a 74-year-old man who underwent laparoscopic rectal cancer surgery. The patient presented with high fever (39 ℃) and acute kidney injury, with serum creatinine rapidly escalating from a baseline of 1.1-2.7 mg/dL. Laboratory evaluation revealed marked hypocomplementemia (C3 35 mg/dL, C4 5 mg/dL), significant proteinuria (1.5 g/day), and hematuria. Catheter tip culture isolated multidrug-resistant Staphylococcus epidermidis. Kidney biopsy demonstrated distinctive pathological findings characterized by endocapillary proliferative glomerulonephritis with massive fibrin deposition, confirmed by phosphotungstic acid-hematoxylin (PTAH) staining. Immunofluorescence revealed granular deposits of IgG and C3 along the capillary wall, notably without IgA or IgM deposits. Electron microscopy identified characteristic fibrin deposits measuring 7-8 nm in thickness, predominantly in the subendothelial region. DnaJ homolog subfamily B member 9 (DNAJB9) staining was negative, definitively excluding fibrillary glomerulonephritis (FGN). Following catheter removal and targeted antibiotic therapy without steroid treatment, the patient's renal function showed remarkable improvement, with creatinine decreasing to 1.8 mg/dL at discharge and further improving to 1.0 mg/dL after 1 year. This case demonstrates that S. epidermidis can induce severe glomerular lesions through fibrin deposition within an extraordinarily short timeframe, contrasting dramatically with the immune complex-mediated injury typically observed in long-term CVC use.

中心静脉置管后不久发生与表皮葡萄球菌感染有关的肾脏疾病1例。
中心静脉导管(CVC)相关的肾脏疾病在长期使用导管的病例中有充分的文献记载,典型表现为膜增生性肾小球肾炎,在数月至数年的导管放置后伴免疫球蛋白(Ig)M和C3沉积。我们报告一个罕见的病例,快速进展的肾脏疾病,发展仅7天后CVC插入在74岁的男子谁接受腹腔镜直肠癌手术。患者表现为高烧(39℃)和急性肾损伤,血清肌酐从基线1.1-2.7 mg/dL迅速升高。实验室评估显示明显的补体不足(C3 35 mg/dL, C4 5 mg/dL),明显的蛋白尿(1.5 g/d)和血尿。导管尖端培养分离出耐多药表皮葡萄球菌。肾活检表现为毛细血管内增生性肾小球肾炎伴大量纤维蛋白沉积,经磷钨酸-苏木精(PTAH)染色证实。免疫荧光显示沿毛细血管壁有颗粒状的IgG和C3沉积,明显没有IgA或IgM沉积。电镜检查发现特征性纤维蛋白沉积厚度为7-8纳米,主要分布在内皮下区域。DnaJ同源亚家族B成员9 (DNAJB9)染色为阴性,明确排除原纤维性肾小球肾炎(FGN)。在不使用类固醇治疗的情况下,患者在拔管和靶向抗生素治疗后,肾功能明显改善,出院时肌酐降至1.8 mg/dL, 1年后进一步改善至1.0 mg/dL。该病例表明,表皮葡萄球菌可在极短的时间内通过纤维蛋白沉积诱导严重肾小球病变,这与长期使用CVC通常观察到的免疫复合物介导的损伤形成鲜明对比。
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来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
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