J Korean Med Sci.  2007 Dec;22(6):1074-1078. 10.3346/jkms.2007.22.6.1074.

A Case of Post-Streptococcal Glomerulonephritis with Diffuse Alveolar Hemorrhage

• Sung HY
• Lim CH
• Shin MJ
• Kim BS
• Kim YO
• Song HC
• Kim SY
• Choi EJ
• Chang YS
• Bang BK

• KMID: 1785773
• DOI: http://doi.org/10.3346/jkms.2007.22.6.1074

Abstract

Acute post-streptococcal glomerulonephritis (PSGN) is characterized by an abrupt onset of edema, hypertension, and hematuria. Life-threatening diffuse alveolar hemorrhage (DAH) is rarely associated with acute PSGN. There have been only two reported cases worldwide, and no case has been reported previously in Korea. Here, we present a patient who clinically presented with pulmonary-renal syndrome; the renal histology revealed post-infectious glomerulonephritis of immune complex origin. A 59-yr-old woman was admitted with oliguria and hemoptysis two weeks after pharyngitis. Renal insufficiency rapidly progressed, and respiratory distress developed. Chest radiography showed acute progressive bilateral pulmonary infiltrates. The clinical presentation suggested DAH with PSGN. Three days after treatment with high-dose steroids, the respiratory distress and pulmonary infiltrates resolved. Electron microscopy of a renal biopsy specimen sample revealed diffuse proliferative glomerulonephritis with characteristic subendothelial deposits of immune complex ("hump''). The renal function of the patient was restored, and the serum creatinine level was normalized after treatment.

Keyword

Post-Streptococcal Glomerulonephritis; Diffuse Alveolar Hemorrhage

MeSH Terms

Biopsy
Female
Glomerulonephritis/*etiology
Hemorrhage/*etiology
Humans
Kidney/pathology
Lung Diseases/etiology
Middle Aged
*Pulmonary Alveoli
Streptococcal Infections/*complications

Figure

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  Fig. 1 Chest radiography on admission showed bilateral pulmonary infiltrates with blunting of both costophrenic angles (A), and chest radiography on the fourth hospital day showed that the pulmonary edema and infiltration were progressing (B). The chest abnormalities resolved after three days of steroid treatment (C).

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  Fig. 2 The CT revealed bilateral pleural effusion and alveolar consolidation or alveolar hemorrhage at both middle and lower lung fields.

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  Fig. 3 The lung biopsy on light microscopy showed eosinophils, neutrophils, and nuclear dust deposition in the alveolar interstitium, septal thickening, and fibrin clots attached to the interalveolar septa (A, H&E ×200; B, H&E ×400).

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  Fig. 4 The renal biopsy specimen on light microscopy showed proliferative glomerulonephritis with neutrophils in the masangium (A, H&E ×200, B, H&E ×400; C, H&E ×400). Electron microscopy showed mesangial hypercellularity with neutrophils and subendothelial electron-dense deposits (D, E).

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