{"title":"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。","authors":"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","doi":"10.1007/s13730-025-01029-7","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":" ","pages":""},"PeriodicalIF":0.7000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A case of kidney disease related to Staphylococcus epidermidis infection soon after insertion of a central venous catheter.\",\"authors\":\"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\",\"doi\":\"10.1007/s13730-025-01029-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>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.</p>\",\"PeriodicalId\":9697,\"journal\":{\"name\":\"CEN Case Reports\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.7000,\"publicationDate\":\"2025-09-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CEN Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s13730-025-01029-7\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CEN Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s13730-025-01029-7","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
A case of kidney disease related to Staphylococcus epidermidis infection soon after insertion of a central venous catheter.
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.
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.