1Canberra Hospital, Canberra, Australia
Background: Campylobacter jejunii is a common cause of self-limiting bloody diarrhoea in travellers and is the triggering event in 50-60% of cases of Guillain-Barre syndrome. There is emerging evidence about the link between gastroenterological conditions with many studies already performed demonstrating the exaggerated systemic response to mucosal antigens.
Case Report: A 27 year old man recently returned from Thailand experienced profuse, watery diarrhoea and macroscopic haematuria with non-oliguric acute kidney injury with creatinine peak at 446umol/L and an active urinary sediment. This patient had no known history of autoimmune disease, renal disease or family history of the same. Renal tract imaging revealed normal sized kidneys and no acute obstruction. Urine protein-creatinine ratio was 266 mg/mmol and despite the presence of blood on urinalysis only hyaline and granular casts were present on microscopy without dysmorphic red cell casts.
Glomerulonephritis screen demonstrated a mildly low C3 level at 0.83 g/L but no other significant positive results. Renal biopsy was performed demonstrating crescentic IgA nephropathy with 7 glomeruli with active cellular crescents. Electron microscopy showed mesangial expansion with dense deposits and mild focal podocyte effacement. Stool culture at the time of the presentation was positive for campylobacter jejunii.
Acute treatment consisted of three intravenous pulses of methylprednisolone followed by oral prednisolone which resulted in rapid reduction in serum creatinine. Current creatinine 2 months post-initial presentation is 95 umol/L with a urine protein-creatinine ratio of 77mg/mmol.
Conclusion: The role of the gut microbiome is an emerging field across many disciplines of medicine and a link with IgA nephropathy has been suggested with a difference in both faecal and salivary microbiota between normal individuals and those with IgA nephropathy.
Shyamalee is a Nephrologist working in Canberra with a special interest in Obstetric Medicine.