Steroids for deep-infection-associated glomerulonephritis: a two-edged sword.

has been known for many years. The diagnosis may to clindamycin. The wound infection could not be sometimes be tricky. The suspicion of infection must controlled, and resulted in amputation of the right always be raised if no other cause for glomerulolower limb. Staph. aureus was cultured from a deep nephritis is present. The prognosis is said to be good surgical specimen. A few days after the operation the provided that the infection can be controlled. We patient developed a nephrotic syndrome with hypertenpresent a case where kidney function did not improve sion, macroscopic haematuria, red-cell casts, rapidly spontaneously after removal of the infectious focus, rising serum creatinine, and massive proteinuria. Total but did recover partially after the addition of steroids. haemolytic complement was normal and circulating immune complexes with rheuma factor-binding activity were found. Hepatitis B sAg was positive. Endocarditis Case report was ruled out by negative blood cultures and transoesophageal echocardiography. Ongoing infection was A 54-year-old patient with a long-standing history of evidenced by a WBC scintigraphy showing accumulaarterial hypertension and peripheral vascular insuY- tion of the tracer in the right groin. A kidney biopsy ciency was admitted to the vascular unit because of could not be performed at that time because of proinfected ischaemic ulcers on the right lower limb. Two longed bleeding time, which did not improve after years before admission he had been treated with a left desmopressin. During surgical exploration an infected femoropopliteal bypass graft, combined with a percu- Dacron graft interponate was removed and replaced taneous transluminal angioplasty of the right arteria by a venous graft. After the procedure kidney function femoralis superficialis. A few months later an acute stabilized at a serum creatinine of 595 mmol/l but thrombosis occurred and an embolectomy of the left hardly improved ( Figure 1). A kidney biopsy confemoropopliteal bypass, a dilatation of the distal tained 30 glomeruli, of which eight had extracapillary suture, an embolectomy of the right arteria femoralis crescents. A variable proliferation of the mesangial communis, and a dilatation of the right arteria fem- cells was noted. When recovery of renal function had oralis superficialis were performed. This was followed failed to occur after 2 weeks, steroids were added at by interposition of a Dacron patch between the right an initial daily dose of 48 mg methylprednisolone, and arteria femoralis communis and arteria profunda gradually tapered oV. A slow decrease in serum creatinfemoris, and a reversed venous femorotibial bypass ine was seen afterwards ( Figure 1). There were no originating from the interponate. Fourteen months other infectious complications. Inflammatory parabefore admission an angioplasty of the right arteria meters returned to normal, but microscopic haematuria