Patients on long-term home parenteral nutrition (HPN) occasionally develop glomerulonephritis due to chronic central venous catheter (CVC)-related infection. Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. Chronic bacteremia as a complication of long-term HPN may cause various types of glomerulonephritis including, rarely, AAG requiring immunosuppressive therapy.

Department of Clinical and Molecular Pathology Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czechia

Department of Nephrology General University Hospital Prague Czechia

Department of Pediatrics Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czechia

Department of Pediatrics University Hospital Olomouc Olomouc Czechia

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De Graeff N, Groot N, Brogan P, Ozen S, Avcin T, Bader-Meunier B, et al. European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides − the SHARE initiative. Rheumatology. 2019;58:656–671. PubMed

Walsh M, Merkel PA, Peh CA, Szpirt W, Guillevin L, Pusey CD, et al. Plasma exchange and glucocorticoid dosing in the treatment of anti-neutrophil cytoplasm antibody associated vasculitis (PEXIVAS): protocol for a randomized controlled trial. Trials. 2013;14:73. PubMed PMC

Yared G, Seidner DL, Steiger E, Hall PM, Nally JV. Tunneled right atrial catheter infection presenting as renal failure. JPEN J Parenter Enteral Nutr. 1999;23((6)):363–365. PubMed

Ohara S, Kawasaki Y, Takano K, Isome M, Nozawa R, Suzuki H, et al. Glomerulonephritis associated with chronic infection from long-term central venous catheterization. Pediatr Nephrol. 2006;21((3)):427–429. PubMed

Kusaba T, Nakayama M, Kato H, Uchiyama H, Sato K, Kajita Y. Crescentic glomerulonephritis associated with totally implantable central venous catheter-related Staphylococcus epidermidis infection. Clin Nephrol. 2008;70((1)):54–8. PubMed

Sy J, Nast CC, Pham PTT, Pham PCT. Membranoproliferative glomerulonephritis in patients with chronic venous catheters: a case report and literature review. Case Rep Nephrol. 2014;2014:1. PubMed PMC

Hayashi S, Mori A, Kawamura T, Ito S, Shibuya T, Fushimi N. Glomerulonephritis caused by CV catheter-related blood stream infection. Intern Med. 2015;54:2219–2223. PubMed

Okada M, Sato M, Ogura M, Kamei K, Matsuoka K, Ito S. Central venous catheter infection-related glomerulonephritis under long-term parenteral nutrition: a report of two cases. BMC Res Notes. 2016;9:196. PubMed PMC

Haffner D, Schindera F, Aschoff A, Matthias S, Waldherr R, Schärer K. The clinical spectrum of shunt nephritis. Nephrol Dial Transplant. 1997;12:1143–1148. PubMed

Ghosh GC, Sharma B, Katageri B, Bhardwaj M. ANCA positivity in a patient with infective endocarditis-associated glomerulonephritis: a diagnostic dilemma. Yale J Biol Med. 2014;87:373–377. PubMed PMC

Csernok E, Lamprecht P, Gross WL. Clinical and immunological features of drug-induced and infection-induced proteinase 3-antineutrophil cytoplasmic antibodies and myeloperoxidase-antineutrophil cytoplasmic antibodies and vasculitis. Curr Opin Rheumatol. 2010;22((1)):43–8. PubMed

Kakoullis L, Parperis K, Papachristodoulou E, Panos G. Infection-induced myeloperoxidase specific antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis: a systematic review. Clin Immunol. 2020;220:108595. PubMed

Hruskova Z, Tesar V. News in the treatment of ANCA-associated vasculitides. Kazuistiky v alergologii, pneumologii a ORL. 2013;10((4)):3–8.