Rapidly progressive glomerulonephritis following Chlamydia pneumoniae pneumonia in a child

Acute renal failure following Chlamydia pneumoniae pneumonia is rarely reported in adults. We present an observation in a 6-year-old child, with hydronephrosis of 3 degrees to the right and the left uninhabited lodge from birth, who had C. pneumoniae pneumonia treated with macrolide antibiotics for a period of 10 days, without any other nephrotoxic drug, in particular nonsteroidal anti-inflammatory drugs. The etiological investigations showed positive C. pneumoniae antibodies, reduced serum concentrations of C3 complement. No uveitis was noted. The diagnosis was rapidly progressive glomerulonephritis after Chlamydia pneumoniae infection and hemolytic anemia in a child with only one kidney. C. pneumoniae pneumonia should be considered a differential diagnosis of community-acquired pneumonia, especially in cases of poor response to conventional antibiotic therapy. It may be associated with tubulointerstitial nephropathy and/or glomerulonephritis whose severity varies in children as in adults Early and effective treatment of C. pneumoniae infection with macrolide antibiotics usually provides favorable progression of renal function. Introduction We report an unusual case of a 6 years old sicilian boy with only one kidney affected by progressive glomerulonephritis after Chlamydia pneumoniae infection and hemolytic anemia. We had treated with macrolide antibiotics for a period of 10 days with seriated serological surveys that documented a progressive decrease in antibody titer. After 2 months, in a visit to the surgery of pediatric nephrology, our patient had diffuse petechial lesions. Blood tests showed thrombocytopenia and therefore has been practiced therapy with immunoglobulins and corticosteroids, with resolution of symptoms. We also conducted the examination of the bone, in the suspicion of a Fanconi anemia, but it was negative. Case summary Our patient is a third son, born at term by normal pregnancy with neonatal phenomena reported in the norm. Breastfeeding for one month, after artificial. Weaning from the fourth month. Psychomotor development and growth in height-weight standard. On the second day of life, after pielic dilation detected during fetal ultrasound, ultrasound scan was performed and showed a picture of hydronephrosis of 3 degrees to the right and the left uninhabited lodge. Thus the child came to undergo surgery to reduce hydronephrosis to the right. He comes to our attention at age 4, when in the course of an acute febrile episode, presents gross hematuria. The tests performed showed severely impaired renal function, hypocomplementemia (C3), a positive direct Coombs test and frankly pathological urine, with a carpet of red blood cells and proteinuria. The history and clinical findings allow us to affirm that our patient had a hyperacute glomerulonephritis with chronic renal failure and hemolytic anemia. The immunological process triggered by infectious cause has been documented by hypocomplementemia (C3) and by a positive direct Coombs test. Because hyperacute onset of glomerulonephritis with acute renal failure and severe anemia with positive direct Coombs test we performed steroid boluses followed by oral steroid therapy. Furthermore, the investigations have documented a positive for chlamidya pn. So we have practiced therapy with macrolide for ten days with serological surveys that had documented a progressive decrease in antibody titer. We have performed also kidney ultrasound which confirmed the picture of compensatory hypertrophy of the right kidney (49 mm, 115 mm) with loggia left renal uninhabited. (Fig. 1-2)