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Remission of FSGS after Hemolytic Uremic Syndrome due to Streptococcus pneumoniae Peritonitis

Kathryn H Pade, Rachel M Lestz


Background: Hemolytic Uremic Syndrome (HUS) resulting from streptococcal pneumoniae infection has been well described in association with pneumonia, empyema and bacteremia. However, it has not been well reported in association with S. pneumoniae as the causative agent of spontaneous bacterial peritonitis (SBP).

Case: We report the case of a 4 year-old patient with biopsy-proven focal segmental glomerulosclerosis (FSGS) who developed clinical SBP with S. pneumoniae bacteremia. The patient subsequently developed hemolytic uremic syndrome with associated renal failure, hemolysis, uremia and thrombocytopenia. The patient recovered from HUS and has remained in clinical remission of nephrotic syndrome with normal renal function since his recovery. He has not required any immunomodulatory or immunosuppressive therapy since his presentation over one year ago.

Conclusions: The patient’s clinical and laboratory recovery from FSGS suggests an immunologic mechanism for recovery and possible cure of this progressive disease.


Keywords: nephrotic syndrome, peritonitis, streptococcus pneumoniae, atypical hemolytic uremic syndrome, proteinuria, remission


Gorensek MJ, Lebel MH, Nelson JD (1988) Peritonitis in children with nephrotic syndrome. Pediatrics 81:849-856

Uncu N, Bülbül M, Yildiz N, Noyan A, Koşan C, Kavukcu S, Calişkan S, Gündüz Z, Beşbaş N, Gür Güven A (2010) Primary peritonitis in children with nephrotic syndrome: results of a 5-year multicenter study. Eur J Pediatr 169:73-76

Tain YL, Lin G, Cher TW (1999) Microbiological spectrum of septicemia and peritonitis in nephrotic children. Pediatr Nephrol 13:835-837

Adhikari M, Coovadia HM (1993) Abdominal complications in black and Indian children with nephrotic syndrome. S Afr Med J 83:253-256

Constantinescu AR, Bitzan M, Weiss LS, Christen E, Kaplan BS, Cnaan A, Trachtman H (2004) Non-enteropathic hemolytic uremic syndrome: causes and short-term course. Am J Kidney Dis 43:976-982

Mizusawa Y, Pitcher LA, Burke JR, Falk MC, Mizushima W (1996) Survey of haemolytic-uraemic syndrome in Queensland 1979-1995. Med J Aust 165:188-191

Manenti L, Gnappi E, Vaglio A, Allegri L, Noris M, Bresin E, Pilato FP, Valoti E, Pasquali S, Buzio C (2013) Atypical haemolytic uraemic syndrome with underlying glomerulopathies. A case series and a review of the literature. Nephrol Dial Transplant 28:2246-2259

Hoefs JC, Runyon BA (1985) Spontaneous bacterial peritonitis. Dis Mon 31:1-48

Copelovitch L, Kaplan BS (2008) Streptococcus pneumoniae-associated hemolytic uremic syndrome. Pediatr Nephrol 23:1951-1956

Copelovitch L, Kaplan BS (2010) Streptococcus pneumonia-associated hemolytic uremic syndrome: classification and the emergence of serotype 19A. Pediatrics 125:e174-182

Banerjee R, Hersh AL, Newland J, Beekmann SE, Polgreen PM, Bender J, Shaw J, Copelovitch L, Kaplan BS, Shah SS (2011)Streptococcus pneumoniae-associated Hemolytic Uremic Syndrome Among Children in North America. Pediatr Infect Dis J 30:736-739

Huang DT, Chi H, lee HC, Chiu NC, Huang FY (2006) T-antigen activation for prediction of pneumococcus-induced hemolytic uremic syndrome and hemolytic anemia. Pediatr Infect Dis J 7:608-610

Wingen AM, Müller-Wiefel DE, Schärer K (1985) Spontaneous remissions in frequently relapsing and steroid dependent idiopathic nephrotic syndrome. Clin Nephrol 23:35-40

Barness LA, Moll GH, Janeway CA (1950) Nephrotic syndrome: Natural History of the Disease. Pediatrics 5:486-503

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