Acute glomerulonephritis associated with pneumonia: A possible Chlamydia pneumoniae etiology?

.Patient reportA 10-year-old, previously well girl was referred to ourhospital because of hematuria, proteinuria and peripheraledema after an episode of pneumonia. Since about 2 weekspreviously, she had been suffering from moderate fever,cough and fatigue. She visited a physician and wasdiagnosed as having pneumonia. A week-long course ofcefdinir (CFDN) therapy was not effective. Thus, mino-cycline (MINO) was started and resulted in improvement ofher clinical condition. After a 1-week course of MINO, shewas noted to have a puffy face and significant hematuria andproteinuria without oliguria. On admission, her bodytemperature was 36.8°C and blood pressure was140/90 mmHg. Her bodyweight was 30.5 kg, which wasretrospectively found to be 1.5 kg more than her disease-freeweight. No skin or mucosal lesions were observed. Physicalexamination was unremarkable except for peripheral edema.The chest x-ray still showed left lower lobe pneumonia.Urinalysis showed a specific gravity of 1.020, protein of154 mg/dL, 30 red blood cell sediments per high-poweredfield and a few granular casts with a sterlie culture.Laboratory studies showed the following values: white bloodcells, 5950 /µL; hemoglobin, 10.6 g/dL; hematocrit, 33%;platelets, 217 000 /µL; serum total protein, 6.7 g/dL;albumin, 3.6 g/dL; total cholesterol, 129 mg/dL; ureanitrogen, 10 mg/dL; creatinine, 0.62 mg/dL; sodium,143 mEq/L; potassium, 4.3 mEq/L; chloride, 110 mEq/L;calcium, 8.6 mg/dL; C-reactive protein, 0.64 mg/dL anderythrocyte sedimentation rate 45 mm/h. No pathogenicbacteria were isolated from her throat and sputa cultures.The results of immunologic examinations were as follows:IgG, 2436 mg/dL; IgA, 214 mg/dL; IgM, 310 mg/dL; anti-nuclear antibody (ANA), 1:80 with a homogenous pattern;anti-DNA antibody, less than 1.0 IU/mL (radioimmunoassay(RIA)); anti-streptolysin 0 (ASO), 1:160, anti-streptokinase(ASK), 1:1,280 and anti-