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Orozco Guillén AO, Velazquez Silva RI, Moguel González B, et al. Acute IgA-Dominant Glomerulonephritis Associated with Syphilis Infection in a Pregnant Teenager: A New Disease Association. J Clin Med. 2019;8(1)doi: 10.3390/jcm8010114.
Orozco Guillén, A. O., Velazquez Silva, R. I., Moguel González, B., Guell, Y. A., Garciadiego Fossas, P., Custodio Gómez, I. G., Miranda Araujo, O., Soto Abraham, V., Piccoli, G. B., & Madero, M. (2019). Acute IgA-Dominant Glomerulonephritis Associated with Syphilis Infection in a Pregnant Teenager: A New Disease Association. Journal of clinical medicine, 8(1), . https://doi.org/10.3390/jcm8010114
Orozco Guillén, Alejandra Oralia, et al. "Acute IgA-Dominant Glomerulonephritis Associated with Syphilis Infection in a Pregnant Teenager: A New Disease Association." Journal of clinical medicine vol. 8,1 (2019). doi: https://doi.org/10.3390/jcm8010114
Orozco Guillén AO, Velazquez Silva RI, Moguel González B, Guell YA, Garciadiego Fossas P, Custodio Gómez IG, Miranda Araujo O, Soto Abraham V, Piccoli GB, Madero M. Acute IgA-Dominant Glomerulonephritis Associated with Syphilis Infection in a Pregnant Teenager: A New Disease Association. J Clin Med. 2019 Jan 18;8(1). doi: 10.3390/jcm8010114. PMID: 30669309; PMCID: PMC6352144.
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J Clin Med. 2019 Jan 18;8(1). doi: 10.3390/jcm8010114.

Acute IgA-Dominant Glomerulonephritis Associated with Syphilis Infection in a Pregnant Teenager: A New Disease Association.

Journal of clinical medicine

Alejandra Oralia Orozco Guillén, Ricardo Ivan Velazquez Silva, Bernardo Moguel González, Yubia Amaya Guell, Pamela Garciadiego Fossas, Iris Guadalupe Custodio Gómez, Osvaldo Miranda Araujo, Virgilia Soto Abraham, Giorgina Barbara Piccoli, Magdalena Madero

Affiliations

  1. Department of Nephrology, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico. [email protected].
  2. Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14080, Mexico. [email protected].
  3. Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14080, Mexico. [email protected].
  4. Department of Foetal Medicine, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico. [email protected].
  5. Department of Infectolog, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico. [email protected].
  6. Department of Gynaecology and Obstetrics, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico. [email protected].
  7. Department of Gynaecology and Obstetrics, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico. [email protected].
  8. Department of Pathology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14000, Mexico. [email protected].
  9. Department of Clinical and Biological Sciences University of Torino, 10043 Torino, Italy. [email protected].
  10. Department of Nephrology, Centre Hospitalier Le Mans, 72000 Le Mans, France. [email protected].
  11. Department of Pathology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14000, Mexico. [email protected].

PMID: 30669309 PMCID: PMC6352144 DOI: 10.3390/jcm8010114

Abstract

Chronic kidney disease (CKD) is increasingly recognized as a risk factor in pregnancy; the differential diagnosis between CKD and preeclampsia (PE) may be of pivotal importance for pregnancy management and for early treatment of CKD. Acknowledging this connection may be useful also in a wider context, such as in the case reported in this paper, which for the first time describes an association between syphilis infection and IgA-dominant glomerulonephritis. A 16-year-old woman, referred to a general hospital due to a seizure, was found to be unknowingly pregnant. Based on hypertension and nephrotic proteinuria, she was initially diagnosed with PE. Immunological tests, as well as hepatitis and HIV tests showed negative results. However, secondary syphilis was diagnosed. In discordance with the PE diagnosis, urinalysis showed glomerular microhematuria with cellular casts. Proteinuria and hypertension did not remit after delivery, which was made via caesarean section, due to uncontrolled hypertension, at an estimated gestational age of 29 weeks. A male baby, weighing 1.1 kg (6.5 centile) was born. The baby was hospitalized in the neonatal intensive care unit, where he developed subependymal hemorrhage and thrombocytopenia, and neonatal syphilis was diagnosed. The mother underwent a kidney biopsy one week after delivery, leading to the diagnosis of IgA-dominant postinfectious glomerulonephritis. Mother and child were treated with support and antibiotic therapy, and were discharged in good clinical conditions four weeks later. Four months after delivery, the mother was normotensive without therapy, with normal kidney function and without hematuria or proteinuria. In conclusion, this case suggests that IgA-dominant postinfectious glomerulonephritis should be added to the spectrum of syphilis-associated glomerulonephritides, and underlines the need for a careful differential diagnosis with CKD in all cases of presumed PE. While diagnosis relies on kidney biopsy, urinary sediment, a simple and inexpensive test, can be the first step in distinguishing PE from other nephropathies.

Keywords: IgA dominant glomerulonephritis; chronic kidney disease (CKD); preeclampsia (PE); syphilis related glomerulonephritis

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