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Abstract：
We report the histological changes over time for a patient with infection-related glomerulonephritis (IRGN) that developed in a transplanted kidney. A 47-year-old man had undergone renal transplantation 3 years ago for end-stage kidney disease (ESKD). After several episodes of acute rejection, the patient was in a stable CKD condition. The abrupt development of severe microscopic hematuria and renal dysfunction was observed approximately 2 weeks after the onset of a phlegmon in his right leg. An allograft biopsy showed prominent glomerular endocapillary proliferation on light microscopy, granular C3 deposition on immunofluorescent microscopy, and subepithelial electron-dense deposits on electron microscopy, suggesting IRGN accompanied by moderate interstitial fibrosis and tubular atrophy (IFTA). Positive glomerular staining for nephritis-associated plasmin receptor (NAPlr) and plasmin activity, which are biomarkers of bacterial IRGN, supported the diagnosis. Although the infection was completely cured with antibiotic therapy, renal dysfunction persisted. A re-biopsy of the allograft 2 months later revealed resolution of the glomerular endocapillary proliferation and negative staining for NAPlr/plasmin activity, with worsening IFTA. We showed, for the first time, the chronological changes in infiltrating cells and histological markers of IRGN in transplanted kidneys. Glomerular changes, including NAPlr/plasmin activity staining, almost disappeared after the cessation of infection, while interstitial changes continuously progressed, contributing to ESKD progression.
摘要：
我们报告了在移植肾中发展的感染相关性肾小球肾炎（IRGN）患者随时间的组织学变化。一名47岁的男子3年前因终末期肾病（ESKD）接受了肾移植。在几次急性排斥反应后，患者CKD病情稳定.在他的右腿出现痰后约2周，观察到严重的显微镜下血尿和肾功能不全的突然发展。在光学显微镜下，同种异体移植活检显示肾小球毛细血管内明显增生，免疫荧光显微镜上的颗粒C3沉积，和电子显微镜上的上皮下电子致密沉积物，提示IRGN伴有中度间质纤维化和肾小管萎缩（IFTA）。肾炎相关纤溶酶受体（NAPlr）和纤溶酶活性的肾小球染色阳性，它们是细菌IRGN的生物标志物，支持诊断。尽管感染通过抗生素治疗完全治愈，肾功能障碍持续存在.2个月后，同种异体移植物的重新活检显示肾小球内毛细血管增殖消退，NAPlr/纤溶酶活性阴性染色，随着IFTA的恶化。我们展示了,第一次,移植肾脏中IRGN浸润细胞和组织学标志物的时间变化。肾小球改变,包括NAPlr/纤溶酶活性染色，感染停止后几乎消失了，在间质变化不断发展的同时，有助于ESKD进展。
