Nagamura Tatsunori, Kato Hiroshi, Tashiro Kazue, Kiyozumi Tetsuro
Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
Department of Nephrology and Endocrinology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Am J Case Rep. 2025 Sep 1;26:e948976. doi: 10.12659/AJCR.948976.
BACKGROUND Infection-related glomerulonephritis occurs when immune complexes formed in response to bacterial infection injure the glomerular basement membrane. Here, we describe a rare case of Staphylococcus-induced glomerulonephritis following burn injury. CASE REPORT A 65-year-old woman was admitted to the Emergency Department after sustaining multiple burns from boiling water. She had second-degree burns covering 19% of her total body surface area and received conservative treatment. On day 4, she developed a burn wound infection caused by methicillin-susceptible Staphylococcus aureus and Pseudomonas aeruginosa. Antibiotic therapy was initiated; however, she developed a sudden and rapid deterioration in kidney function on day 15. Sepsis-associated acute kidney injury was initially suspected, and the fluid infusion rate was increased accordingly. However, her kidney function deteriorated further, and she subsequently developed generalized edema. After considering the staphylococcal wound infection, marked hematuria and proteinuria, and hypocomplementemia, the diagnosis was revised to Staphylococcus-induced glomerulonephritis secondary to the burn wound infection. Fluid restriction and intermittent hemodialysis were initiated on day 19 of hospitalization. Her clinical condition improved approximately 1 month later, and a kidney biopsy result on day 74 was consistent with the recovery phase of infection-related glomerulonephritis. The patient was discharged 94 days after admission. CONCLUSIONS Acute kidney injury secondary to a burn wound infection should be distinguished from infection-related glomerulonephritis and sepsis-associated acute kidney injury. Source control and fluid restriction are recommended when infection-related glomerulonephritis is suspected in older patients with staphylococcal wound infections, marked proteinuria or hematuria, and hypocomplementemia.
感染相关的肾小球肾炎是在因细菌感染形成的免疫复合物损伤肾小球基底膜时发生的。在此，我们描述一例烧伤后由葡萄球菌引起的肾小球肾炎罕见病例。
一名65岁女性因被沸水多处烫伤后被收入急诊科。她全身表面积19%为二度烧伤，接受了保守治疗。第4天，她发生了由甲氧西林敏感金黄色葡萄球菌和铜绿假单胞菌引起的烧伤创面感染。开始使用抗生素治疗；然而，在第15天她的肾功能突然迅速恶化。最初怀疑是脓毒症相关的急性肾损伤，并相应增加了液体输注速率。然而，她的肾功能进一步恶化，随后出现全身水肿。在考虑到葡萄球菌创面感染、明显血尿和蛋白尿以及补体血症后，诊断修订为烧伤创面感染继发的葡萄球菌性肾小球肾炎。住院第19天开始限制液体摄入并进行间歇性血液透析。大约1个月后她的临床状况改善，第74天的肾活检结果与感染相关肾小球肾炎的恢复期一致。患者入院94天后出院。
烧伤创面感染继发的急性肾损伤应与感染相关的肾小球肾炎和脓毒症相关的急性肾损伤相鉴别。对于有葡萄球菌创面感染、明显蛋白尿或血尿以及补体血症的老年患者，当怀疑感染相关肾小球肾炎时，建议进行源头控制和限制液体摄入。
