ABSTRACT
Introduction: Infection-related glomerulonephritis is well recognized and often included in the differential diagnosis in patients with ongoing infections. It can be missed, however, if the infection is unusual or undetected. We present three cases where the renal biopsy findings prompted the identification or treatment of systemic infections. Case Description: Case 1: A 84-year-old male presented with acute kidney injury (AKI) and a new purpuric rash. Clinically, IgA nephropathy was suspected. A renal biopsy showed active glomerulonephritis with abundant neutrophils, focal segmental tuft necrosis, and one cellular crescent. Predominantly mesangial immune complex deposits containing IgA and IgG were seen. The findings suggested IgA-rich infection-associated glomerulonephritis. Infectious workup was positive for COVID-19, suggesting exacerbation of IgA nephropathy by recent COVID-19 infection. Case 2: A 31-year-old female status post kidney transplant for granulomatosis with polyangiitis (GPA) had recent pregnancy with preterm delivery, disseminated herpes simplex virus (HSV) infection with HSV hepatitis, and AKI. Urine culture was positive for E. coli. The differential diagnosis included HSV nephritis, drug reaction, rejection, recurrent GPA, thrombotic microangiopathy (TMA), and pyelonephritis. A renal biopsy showed proliferative glomerulonephritis with subendothelial and mesangial immune complex deposits containing IgG and C3. The findings were most consistent with infection-related immune complex glomerulonephritis, most likely related to the HSV infection. Case 3: A 78-year-old female presented with AKI, proteinuria, hematuria, and positive p-ANCA. Clinically, ANCA vasculitis was suspected, and the renal biopsy did show focal, segmental, necrotizing glomerulonephritis. However, immunofluorescence and electron microscopy showed IgM-rich immune complex deposits in the mesangium. The unusual presentation of ANCA glomerulonephritis was suggestive of an underlying infection. Bartonella antibody panel showed very high titers;the patient was treated with antibiotics for Bartonella endocarditis. Discussion(s): Infection-related glomerulonephritis has a wide variety of presentations histologically and clinically. The three cases we present here emphasize the importance of recognizing these entities to help guide treatment and improve patient care.
ABSTRACT
The coronavirus pandemic brought the world to a standstill of historic significance. Countries over the world have imposed lockdowns, quarantines and travel bans in an effort to stop the further spread of the disease. Healthcare systems worldwide are under extreme pressure due to the influx of a large amount of patients suffering from COVID-19. Moreover, there is a dearth of doctors, nurses, and support staff in hospitals of many countries. In such a predicament, it is imperative to leverage the advances made in computer vision and deep learning technologies to create a system that attempts to ease the burden on worldwide healthcare. In this research, ten state-of-the-art pre-trained convolutional neural networks were used to identify COVID-19 in chest Computed Tomography (CT) scan images. After extensive experimental testing and tuning, comprehensive comparative analysis was done and very promising results were obtained in this classification task. © 2021 IEEE