Editorial

Brucella Glomerulonephritis

Authors: Fahim Zaman, MD, FACP, Kenneth Abreo, MD

Abstract

Reports of renal involvement with brucellosis are rare and anecdotal even though patients can excrete brucellae in the urine. Mild proteinuria may be commonly seen with brucellosis. However, cases of interstitial nephritis, pyelonephritis, immunoglobulin (Ig)A and membranous nephropathy, massive proteinuria, and caseating granulomas have all been reported in the literature.1–5 Renal involvement has been classified into three main groups.1–3 Firstly, an acute interstitial nephritis (AIN) with associated proteinuria, hematuria, pyuria, urinary frequency and dysuria, is commonly seen in the acute phase of brucella infection and is caused by direct invasion of the bacterium.3 The interstitial nephritis does not seem to be due to infection of the renal parenchyma but rather an immune response targeting the interstitium. Secondly, a chronic granulomatous interstitial nephritis that mimics renal tuberculosis or chronic pyelonephritis is characterized by lymphocytic infiltrates and occasional granulomas. Thirdly, an immune-complex mediated glomerulonephritis in which circulating antigen-antibody complexes are deposited on the epithelial side of the basement membrane.

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