SHM Converge Scientific Abstract ePoster Gallery-Persistent Aki in Mrsa Bacteremia: Recognizing C3-Dominant Infection-Related Glomerulonephritis

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This case highlights an underrecognized cause of acute kidney injury (AKI): methicillin-resistant Staphylococcus aureus (MRSA)-associated C3-dominant post-infectious glomerulonephritis (PIGN). A 54-year-old man with diabetes, cardiovascular disease, and prior stroke was admitted from a skilled nursing facility with hallucinations, fever, severe hyperglycemia, leukocytosis, and a purulent left foot amputation site. Imaging showed a gas-forming soft tissue infection, and blood cultures grew MRSA. He underwent urgent below-knee amputation for source control and received targeted antibiotics.<br /><br />Although the infection was controlled, his kidney function worsened significantly, with creatinine rising from 1.14 to 4.99 mg/dL, along with gross hematuria and proteinuria. Initial explanations included sepsis-associated acute tubular injury, contrast nephropathy, medication toxicity, and drug interactions. Serologic testing was negative, and renal ultrasound showed no obstruction. Because the renal decline did not improve as expected, the hospitalist team facilitated multidisciplinary discussion and advocated for renal biopsy.<br /><br />Biopsy revealed endocapillary and mesangial hypercellularity with C3-dominant staining and immune-complex deposits, confirming PIGN. With supportive care and continued MRSA-directed therapy, kidney function began to improve, and creatinine decreased to 3.82 mg/dL by discharge. The patient’s mental status returned to baseline, and he completed a six-week course of ceftaroline with outpatient nephrology and infectious disease follow-up.<br /><br />The case emphasizes that staphylococcal bacteremia can trigger PIGN in adults, and that it may closely mimic more common inpatient causes of AKI. Hematuria and proteinuria should raise suspicion for a glomerular process, but biopsy is often necessary for diagnosis. The report also underscores the hospitalist’s role in recognizing an atypical clinical course and advocating for definitive evaluation.

Asset Subtitle

Jack B. Ding

Meta Tag

Author List Jack B. Ding, Lonnie Thach

Category Clinical Vignettes

Concept Acute Kidney Injury

Concept Post-Infectious Glomerulonephritis

Concept Nephritic Syndrome

Concept Staphylococcus aureus Bacteremia

Concept C3-dominant Post-infectious Glomerulonephritis

Distinguished Non-Finalist

Presenter Organization Georgetown University and Medstar Washington Hospital Center

Presenting Author Jack B. Ding

Track Adult

Keywords

acute kidney injury

MRSA

post-infectious glomerulonephritis

C3-dominant

staphylococcal bacteremia

hematuria

proteinuria

renal biopsy

glomerular disease

hospitalist

Acute Kidney Injury

Post-Infectious Glomerulonephritis

Nephritic Syndrome

Staphylococcus aureus Bacteremia

C3-dominant Post-infectious Glomerulonephritis